HealthCare HEDIS Reporting Lead

Amerihealth Caritas • ,

22h • Remote

About The Position

The Healthcare HEDIS Reporting Lead implements the Healthcare Effectiveness Data and Information Set (HEDIS) project plan and ensures that National Committee for Quality Assurance (NCQA) and regulatory reporting requirements are met. The work includes project monitoring, data collection, quality control, and final reporting. The role applies business knowledge and technical expertise to support HEDIS strategies, goals, and initiatives at the corporate and health-plan levels.

This remote role works Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time. A reliable high-speed internet connection is required, with minimum bandwidth of 50 Mbps download and 5 Mbps upload. Fully remote associates residing in states where service is required by contract, law, or regulation may submit for reimbursement.

AmeriHealth Caritas is a mission-driven health care organization headquartered in Newtown Square, with more than 30 years of experience. It provides integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Requirements

• Bachelor’s degree in Business Management and/or Information Systems.
• At least 3 years of work experience in the health care industry.
• At least 1 year of project management experience and HEDIS knowledge.
• Extensive knowledge of Microsoft Office.
• Ability to manage multiple complex projects with strict deadlines.
• Excellent verbal and written communication skills.
• Attention to detail and strong organizational skills.

Nice To Haves

• Strong SQL skills.
• Strong big data and cloud programming skills.

Responsibilities

• Develop and manage the annual enterprise HEDIS project plan, including HEDIS-based regulatory reporting.
• Support the HEDIS onsite audit.
• Facilitate the relationship with the Medical Record Review (MRR) vendor for technical aspects of annual MRR projects.
• Represent the HEDIS team in collaboration with internal departments on HEDIS improvement.
• Support the HEDIS Road Map and other documents required by auditors.
• Ensure data sent to the HEDIS software vendor are accurate and meet reporting timelines.
• Ensure all HEDIS supplemental data sources are represented and accurately reported for data completeness.
• Improve HEDIS reporting processes by leading ongoing lessons-learned processes for internal operational improvement.
• Provide managerial guidance to HEDIS Analysts and Senior HEDIS Analysts to meet deliverables.
• Lead ongoing enhancements to the department’s HEDIS analytics offerings and solutions.
• Translate goals into actionable work plans for individual staff.
• Handle difficult customer situations proactively and tactfully, using them to build stronger working relationships.
• Adjust to changing priorities and assignments, and manage staff workload accordingly.

Benefits

• Flexible work solutions, including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off, including holidays and volunteer events.
• Health insurance coverage for associates and their dependents beginning on Day 1.
• 401(k).
• Tuition reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager