Location: This is a work from home position with the ideal location of Miami, Florida. However, this position can be located anywhere in the state of Florida.
Responsible for assisting with the annual HEDIS medical record collection process is implemented timely and accurately.
Primary duties may include but are not limited to:
- Interfaces with multiple enterprise departments and external vendor to annually field a new HEDIS pursuit application that has been tested for new technical specifications and quality checked that all data feeds are valid and report accurate information from the field medical record abstractions.
- Creation of a web based application that is compliant with the current years NCQA technical specifications measures.
- Analysis of the data base is conducted daily to ensure the final rate output achieves the NCQA auditor's approval for that reporting years hybrid rates to maintain NCQA accreditation and multiple state contract requirements.
- Performs quality checks for multiple external data feeds to application, responsible to coordinate information exchange with external vendors and collaborative partners, train and monitor multiple end users nationally through development of training manuals and classes for application end users.
- Track national field staff data collection daily to ensure annual project accreditation and regulatory submission deadlines are met, participate in onsite accreditation audits , produce and report valid HEDIS measure rate reports to NCQA certified auditor, serve as data resource for internal customer developed requests for ad hoc HEDIS statistics and trended data reports.
- Supports HEDIS and Medicare Star performance improvement operations by providing data analytics and insights.
Minimum Requirements: BS/BA degree in a related field, 3-5 years of data analysis, NCQA accreditation standards and HEDIS technical specifications; or any combination of education and experience, which would provide an equivalent background.
Preferred qualifications, skills and experience : Advanced experience with payer level data interpretation, quality improvement programs, Medicare, Medicaid, and CMS reporting requirements, Microsoft Excel, Microsoft Access, Python and SQL highly preferred.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.