Health Data Analyst - QM

Upper Peninsula Health Plan•Marquette, MI

5d•Hybrid

About The Position

This position is responsible for transforming complex health plan data into meaningful insights that support service delivery, cost management, quality improvement, and access to care. Using medical, dental, and pharmacy claims, hospital utilization data, revenue and enrollment data, the Health Data Analyst partners with internal teams to meet a wide range of analytical and reporting needs. The role also supports quality management initiatives, including Healthcare Effectiveness Data Information Set (HEDIS) and enterprise registry tools, reporting, ensuring accurate and timely quality measure evaluation to guide performance improvement efforts.

Requirements

Minimum: Bachelor’s degree in appropriate science or related discipline such as health information technology, health information management, computer information systems or related field
Minimum: One (1) to three (3) years of coursework related to healthcare data analysis or computer science
Keyboarding proficiency and advanced knowledge of Microsoft Office (Word, Excel, Access, and PowerPoint) including proficiency in database management
Understanding of SQL
Advanced proficiency with Tableau Desktop and Server
Excellent human relation and oral/written communication
Excellent project management and organizational abilities
Ability to work independently and manage multiple tasks effectively
Ability to be flexible and adaptable to changing priorities

Nice To Haves

Preferred: Bachelor’s degree in management information systems, computer science, health informatics, or data analytics.
Preferred: Three (3) to five (5) years working in a healthcare setting with progressive experience in data reporting and project management
Knowledge of terminology and concepts used in the healthcare and health insurance industry
Knowledge of accounting and health-care software systems/applications
Knowledge of claims and coding and billing methodologies
Knowledge of clinical HEDIS, NCQA, and CMS regulations

Responsibilities

Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
Performs all assigned tasks in accordance with UPHP plans, policies and procedures, National Committee for Quality Assurance (NCQA) standards, and all regulatory standards and contractual requirements.
Collaborates with internal health plan staff to define data analysis projects, identify appropriate data sources, and develop meaningful and actionable output. Serves as a super user for quality data and population health web-based applications, providing ongoing support and training for internal and external end-users.
Collects, cleans, and validates healthcare data from multiple sources, including dashboards, scripts, and enterprise registry tools; organizes and analyzes data to identify patterns and trends; develops and maintains data preparation and validation routines; and reviews reports to ensure accuracy and reliability.
Develops and maintains quality payment scorecard reporting processes using SQL and VBA, streamlines monthly code calculations, enhances data accuracy, optimizes value-based payment data pulls, and creates reliable reports and member lists for clinic review.
Develops and maintains provider value-based payment scorecards by ensuring accurate, timely reporting and data validation, and prepares charts, graphs, and tables to meet clinical services reporting needs.
Develop interactive dashboards and analytical reports using tools such as Tableau and Microsoft Excel.
Assures resolution of identified problems in clinical data in conjunction with the medical director, chief quality officer, clinical services managers, HEDIS lead, clinical coordinators, and the Information Systems (IS) department.
Working knowledge of SQL to write, link, and optimize queries for accessing and analyzing complex healthcare data across multiple tables and sources.
Manages quality projects within the Clinical Services department, tracking multiple initiatives and meeting tight deadlines.
Designs, develops, and maintains Microsoft Access databases to support healthcare data storage and analysis, and keeps up-to-date documentation of all processes and work performed.
Demonstrates general knowledge of NCQA standards and HEDIS measures as they relate to clinical reporting.
Attends and participates in organizational, departmental, and clinical team meetings, as well as with external entities when required.
Maintains confidentiality of client data.
Performs other related duties as assigned or requested.