Help us maintain the quality of jobs posted on PowerToFly. Let us know if this job is closed.
Job Details
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Our Quality Reporting Operations team is vital to our success and driving the future growth of UnitedHealth Group. Success in these careers relies on many factors - your ability to deal with ambiguity, your ability to adapt and embrace change, and a long-term commitment to making health care better for everyone. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:
- Facilitate, oversee and monitor on-going business processes to support HEDIS® data reporting
- Monitor compliance against relevant process requirements (e.g., turnaround time, accuracy)
- Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state
- Ensure all business requirements are met
- Demonstrate understanding of relevant organizations' operations, products and applications, strategies, processes, and/or business priorities in order to build effective solutions including development of project plans (e.g., communication plans; implementation steps) to support operations using relevant tools and databases
- Submission of the NCQA Health plan Roadmap General Information, Appendix and Attestation
- Submission of the NCQA Healthcare Organization Questionnaire (HOQ)
- Complete admin and hybrid measure benchmarking and rate review to resolve all CHCA (Auditor) rate outlier concerns throughout the HEDIS® project (Initial, Refresh, Final) on complex projects
- Perform SDS, administrative refresh data loads and vendor medical record event data loads to the hybrid project and update rates
- Perform all MRR project build steps, including QA, to ensure each hybrid MRR project is set up according to business requirements
- Coordinate with medical record vendors on file loads and resolving technical project issues
- Confirmation of all hybrid exclusions entered into HEDIS® software, coordinating clinical review when necessary
- Complete all HEDIS® software upgrade steps as required
- Create and validate all final hybrid frozen counts and deliver to CHCA
- Complete all final hybrid project close steps, including validation of all exclusions and QA of all final data and rates
- Complete all final admin and hybrid project processing
- Creation of IDSS exports and submission to NCQA
- Creation of PLD exports and submission to CHCA and/or CMS
- Submission of State required reporting if applicable
- Coordinate efforts with the LOB Operations team to ensure all business requirements and deliverables are met
- May also assist in supporting chase status updates, chase activations, query exports and special request data analysis or validation
- Monitor and analyze business process information (e.g., metrics; analytics) to identify key issues, trends, and potential root causes (e.g., training issues; lack of understanding by user community) that point to improvement opportunities
- Participate in analysis of project outcomes to generate data driven recommendations for process improvement
- Lead and participate in workgroups to implement process improvement and/or in preparation to meet business requirements
- Participate in HEDIS® software system testing efforts to ensure project preparedness
- Use a process driven approach to identify root cause and process improvement opportunities
- Demonstrate and remain current in understanding of relevant regulations and systems
- Complete all required training for job role and stay current on all HEDIS® technical specifications and software systems
- Develop proficiency in HEDIS® software tools and HEDIS® and other required quality metric reporting specifications
- General knowledge of HEDIS® impacts for each LOB, i.e. Accreditation, STARs, FEHB, State, etc.
- Summarize and communicate proposed solutions with the appropriate audiences
- Resolve all CHCA (Auditor) Issue Log concerns for projects assigned
- Communicate potential impacts and risks associated with implementing proposed solutions to business partners and relevant stakeholders
- Timely escalation of all issues and barriers to Manager, QSD Projects (MQP)
- Assesses and interprets customer needs and requirements
- Identifies solutions to non-standard requests and problems
- Solves moderately complex problems and/or conducts moderately complex analyses
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Translates concepts into practice
- Provides explanations and information to others on difficult issues
- Coaches, provides feedback, and guides others
- Acts as a resource for others with less experience
- 3+ years of experience in analysis and reporting
- 2+ years HEDIS® or CMS stars experience
- Experience interpreting and analyzing large amounts of data from multiple sources
- Healthcare experience
- Intermediate proficiency in MS Excel
- Proven excellent communication, time/project management, problem solving, organizational, and analytical skills
- Demonstrated ability to manage and prioritize deliverables
- Experience creating reports
- Proficient in use of certified HEDIS® software
- Advanced proficiency in MS Excel
- Ability to work without a lot of direction
- Team player
- Solid communication skills
- Organized
- Ability to manage multiple projects at a time
About the Company
UnitedHealth Group
Minnetonka, MN, United States
UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are... Read more