Manager, HEDIS - Plan

Job Details

The Healthcare Economics (HCE) team's primary function is to provide various clinical and financial analyses to management to support the business decision process. In addition, the team will provide consistent, accurate reports to help management from other departments do their jobs more effectively.
The manager will oversee regulatory audit activities for HEDIS and lead the efforts surrounding data collection, software development, quality review of data and rate generation. The manager will be directly responsible on ensuring compliance and timely submission of the annual HEDIS project for all lines of business as well as all relevant activities to ensure successful outcome

Job Description

Summary
The Healthcare Economics (HCE) team's primary function is to provide various clinical and financial analyses to management to support the business decision process. In addition, the team will provide consistent, accurate reports to help management from other departments do their jobs more effectively. The manager will oversee regulatory audit activities for HEDIS and lead the efforts surrounding data collection, software development, quality review of data and rate generation. The manager will be directly responsible on ensuring compliance and timely submission of the annual HEDIS project for all lines of business as well as all relevant activities to ensure successful outcome

Job Duties

• Able to work in a constant state of alertness and safe manner
• Manage the entire HEDIS and Pennsylvania EQRO process
• Supervise and manage analyses for senior management and other departments to assure accuracy and integrity of work performed and relevance to the business needs identified.
• Manage and motivate analysts to meet and exceed service requirements and functional objectives.
• Coach and lead HEDIS team to continuously improve performance and value.
• Work with other department leaders to define and implement their reporting needs with regard to HEDIS and serve as a broker of available information.
• Assure that HEDIS staff meet the requirements of their reporting departments and that practices are in compliance with company standards.
• Coordinate, assign and respond to data requests from other departments. Maintain and foster a collaborative relationship with these departments.
• Participate in companywide initiatives such as new system implementations, quality and process improvement. Ensure that data and reporting needs are considered in plan-wide initiatives.
• Create accurate and meaningful utilization and outcome analysis, trend and other reports for departmental and management HEDIS related decision-making using Hyperion, MS Access, MS Excel and other reporting tools as necessary. .
• Help determine optimal analysis and presentation of medical data to improve service quality. Direct use of dashboards, presentations, and spreadsheet reports accordingly.
• Work with IS to ensure that optimal business and reporting tools are available for HEDIS, STARS and other company users. Monitor data initiatives with IS, Operations and other departments to ensure accuracy and consistency and to avoid duplication of effort.
• Understand and communicate to HEDIS staff how changing business practices will affect data and reporting, and implement the necessary changes efficiently and accurately.
• Other responsibilities as assigned.

Minimum Qualifications

• Bachelor’s Degree or higher degree in actuarial science, mathematics, statistics or other analytical field of study.
• 4 years of data reporting and analysis experience with at least 2 years of clinical/healthcare data experience in managed care and/or medical quality assurance setting or other relevant experience.
• Experience with Medicaid and Medicare insurance and populations. Experience with provider coding practices using CPT, ICD-10 codes, and DRG’s.
• Understanding of delivery and reimbursement of medical services in a managed care environment. Familiarity with the role disease management, utilization management and care management play in a managed care organization.
• HEDIS program management required.
• Proven leadership or mentoring skills with a data analysis team.
• Strong problem-solving, quantitative and analytical skills.
• Ability to use business intelligence query tools, computer spreadsheet (Excel), and database (Access and others, including Visual Basic) at advanced level.
• Ability to manage technical staff; management experience a plus.
• Proven skills with data presentation including charts, graphs and other exhibits.
• Ability to communicate effectively both orally and in writing.
• Ability to negotiate workable solutions to customer needs.
• Ability to learn quickly and implement knowledge of new technical processes with assistance of business unit experts.
• Ability to handle multiple responsibilities and changing priorities.
• Excellent organizational skills.

Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

For more benefits information, please click here