Quality Data Validation Analyst

The Quality Data Validation Analyst is responsible for improving the quality and completeness ofdata used for Partnership’s Healthcare Effectiveness Data Information Set (HEDIS) reportinginitiative. This position will focus on sets of measures required by federal and state regulatorybodies and collaborates with internal and external stakeholders to improve the exchange of clinicaldata that meets the requirements for use in the reporting and ensures that services completed withinPartnership’s provider network are accurately leveraged in the HEDIS Project. This position is akey stakeholder on Partnership’s implementation of a Data Aggregator vendor solution and willpartner with the vendor and internal stakeholders to maximize the impact of the Data Aggregatorsolution on HEDIS rates.

Responsibilities

Understands and improves data sources and data exchange pathways for HEDIS measures,working collaboratively with Partnership departments (IT, QI, Finance, Claims, HealthServices, Analytics teams) and external stakeholders (Partnership provider network, CountyDPH’s, DHCS, contracted vendors).o Identifies and quantifies issues and points of failure that prevent completed serviceswithin the provider network from impacting measure rates.o Proposes and leads initiatives to resolve identified data exchange issues, incollaboration with multiple internal and external stakeholders.o Leads evaluation of initiatives to resolve clinical data exchange issues to improvemeasure performance. As Subject Matter Expert on Data Aggregator vendor solution, participates in strategicplanning around implementation across the provider network and across measures for theMedicaid and Medicare lines of business. Analyzes plan-wide, county, regional, and practice level trends in measure performance. Develops analytic tools, methodologies and communication strategies to monitor dataexchange around key quality measures, in collaboration with QI, Regional leadership, Claims,and other Partnership departments, Creates and maintains thorough and consistent documentation of data exchange tools andmethodologies. Communicates information about clinical data exchange and impacts on measure performanceto internal and external stakeholders. Stays up to date on changes in federal and state reporting requirements and specifications,vendor landscape around HEDIS, and NCQA initiatives. Participates in special projects as needed.

Qualifications

Education and Experience

Bachelor’s degree with concentration in health informatics, publichealth, data science, epidemiology, statistics or related field, Master’sdegree preferred. Minimum five (5) years of experience in dataanalysis and reporting, including two (2) years of experience in healthcare data systems (Medicaid or Medicare experience a plus). Excellentknowledge of data collection, analysis, statistics and data presentationwith experience supporting data exchange between large informationsystems.

Special Skills, Licenses and Certifications

Proficiency in statistical analysis, SQL, Excel, Tableau. Understandingof health data formats including claims, lab and pharmacy. Knowledgeof clinical coding systems (e.g., ICD9, ICD10, CPT). Experience usingand interpreting NCQA HEDIS Technical Specifications (or similarclinical measure technical specifications). Experience using NCQAcertified Data Aggregator preferred.

Performance Based Competencies

Ability to quickly acquire in-depth knowledge of various systemsrelated to NCQA technical specifications, data aggregator vendorsolutions, healthcare information exchange, claims data, membership,provider, and benefits data at Partnership. Excellent analytical skills totroubleshoot and resolve data issues in alignment with NCQA HEDISspecifications. Must be highly organized and proficient at multitasking. Strong written and oral communication skills with ability tointerpret and understand technical requirements and communicatetechnical concepts to a non-technical audience.

Work Environment And Physical Demands

Ability to use a PC with standard software packages. More than 70% ofwork time is spent in front of a computer monitor. Periodic travel to inperson meetings is required. When necessary, the ability to lift, carry,or move manuals and reports, weighing up to 25 lbs. Must be able towork in a fast paced environment and maintain courtesy andcomposure when dealing with internal and external customers.

All HealthPlan employees are expected to:

Provide the highest possible level of service to clients;

Promote teamwork and cooperative effort among employees;

Maintain safe practices; and

Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$118,518.94 - $154,074.63

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Regular Full-Time