HEDIS Stars Data Subject Matter Expert - Clinical and Quality Solutions - Telecommute

We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and ability to develop and implement effective, strategic business solutions through analysis of data and business processes. It's the opportunity to do your life's best work.(sm)
 
As HEDIS STARS Subject Matter Expert, you have is an opportunity to utilize your strong understanding of Healthcare information, particularly HEDIS, to analyze data. We will need your understanding of supplemental data concepts for HEDIS to perform as a data consultant.  You will also utilize expertise in health plan data; Member, Enrollment, Provider, Lab, Visits, Pharmacy, etc. In this role, you will develop data driven metrics to identify gaps and implement interventions to improve results on key performance measures.
 
Primary Responsibilities:

Utilize thorough understanding of measure analytics to perform investigative research
Evaluate and prioritize recommendations for quality improvement to customers
Translate data from various formats and data warehouses
Merge and append data from various sources
Perform Data Validation
Own and execute HEDIS requirements
Translate technical specifications
Provide guidance to clients on data issues and data questions
Demonstrate knowledge of claims and claims processing
Consistently follow published HEDIS and Stars technical specifications
Provide strategic support in preparation of the HEDIS Roadmap, HOQ, HEDIS audit
Manage and prioritize large projects with great visibility

Requirements

Bachelor's Degree or HS Diploma/GED with equivalent experience
5+ years of experience in a health care delivery organization, such as a managed care organization
5+ years of HEDIS experience, performing a wide range of functions with strong focus on data analysis
5+ years of data analysis experience
5+ years working with final submission files to NCQA, CMS, California P4P, NY QARR, and/or other state submissions.
3+ years of writing SQL code
Intermediate knowledge of Excel
Knowledge of Medicaid and/or Medicare programs
Knowledgeable of current trends in HEDIS in managed health care
Understand basic concepts of CMS Quality Rating System
1+ years of experience working in a matrix environment
Preferred Qualifications:

STARS experience
Knowledge of NCQA, CMS, HOS, and CAHPS requirements
Familiarity with ICD-9-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
 
 
Job Keywords: HEDIS Stars Data Subject Matter Expert, Clinical and Quality Solutions, telecommuter, telecommute, work from home