Sr Quality Data Analyst - Plan
Job ID 2012-21547
# Positions 1
Location US-NY-New York
US-NY-New York
Search Category Health Care Operations
Type Regular Full-Time (30+ hours)
Posted Date 12/27/2012
Additional Locations US-NY-New York
More information about this job:
Summary:
To develop, maintain and enhance mechanisms to track, trend, and report quality measures and compliance reports for the health plan(s). To support the continuous quality improvement process needs of the Quality Department and Risk Control and Compliance Operations through comprehensive analysis, documentation and reporting of data pertaining to company performance and compliance goals.
Responsibilities:
1. Collaborates with business data owners to develop, analyze, maintain and submit reports used to measure, monitor and manage quality of care, service, compliance and quality improvement initiatives.
2. Assists in the data analysis, development, reporting and submission of mandatory Health Plan reports to Health and Human Services and other regulators.
3. Manages and validates HEDIS data and projects; assure data integrity and reporting of rates.
4. Develops and utilizes knowledge of databases, information systems, managed care, Medicaid/CHIP population, statistical tools and analytical principles to analyze quality outcomes that support strategies for managing health plan performance.
5. Participates in quality initiatives by assisting with data analysis, project design, inter-rater reliability studies and project documentation.
6. Compiles and analyzes data including comparison of outcome measures to benchmark, identifying trends, completing barrier analysis, and assisting in the identification of activities to reach performance goal. Assures completion, accuracy and timeliness of all reports and data.
7. Performs statistical tests to determine statistical significance, confidence level, validity and reliability of outcome.
8. Supports systems to provide trended data related to member satisfaction, complaint and appeal processes, provider satisfaction, provider access and availability, and other areas required for the quality program evaluation.
9. Conduct troubleshooting with management and IT as problems in data management systems arise to promote consistency in reporting.
10. Participates in clinical focus study development, data collection, analysis and report writing.
11. Coordinates clinical focus study activities, serving as project lead, as assigned.
12. Actively participates in plan-wide or state-wide preparation for accreditation surveys and regulatory audits by creating and maintaining compliance roadmaps, as assigned.
13. Develops, maintains and standardizes reports for State quality and compliance reporting.
14. Functions as expert in QM data retrieval and reporting.
Qualifications:
EDUCATION AND EXPERIENCE
Education
Required:
• Bachelor’s degree in business, science, healthcare or related field preferred. Equivalent experience considered.
• 3-5 years data analysis or statistical experience or successful completion of Amerigroup Leadership Development Program in lieu of years of experience.
• Proficient with window based environment, particularly Microsoft Excel and Access. Working knowledge of information systems including database design.
• Previous HMO/Managed Care industry experience preferred.
• Knowledge of SPSS, Minitab and SQL preferred.
• Understanding of ICD-9 and CPT coding system helpful.
Knowledge and Skills
• Excellent analytic skills, attention to detail.
• Detailed familiarity with computer systems, word processing, spreadsheet, statistical packages and other data base management software.
• Good organizational skills; the ability to handle multiple priorities simultaneously with a high quality result.
• Excellent writing skills.
• Appreciation of cultural diversity towards target population.
Physical Requirements
• Must be able to operate a computer.
• Must be able to operate a telephone.
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