HEDIS Business Information Consultant

HEDIS Business Information Consultant

Location: This position will take part in Elevance Health’s hybrid workforce strategy which includes virtual work and 1-2 days physically in office per week .

Associates are required to live within a 50-mile radius and a 1-hour commute to one of our Elevance Health major office (PulsePoint) locations. Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.

The HEDIS Business Information Consultant is responsible for serving as an expert in data analysis, reporting and formulating recommendations, and providing guidance to other data analysts.

The position is part of the Enterprise HEDIS Analyst Team . It will be responsible for working with management and peers on the end-to-end HEDIS submissions for a grouping of contracts, audit activities, benchmarking, testing, measure validation, IDSS/PLD submission, state-required reporting, and health plan liaison.

How You Will Make an Impact

Primary duties may include, but are not limited to:

• Creates and maintains databases to track business performance.

• Analyzes data and summarizes performance using summary statistical procedures.

• Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.

• Creates and publishes periodic reports, as well as any necessary ad hoc reports.

• May require taking business issues and devising the best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.

• May make recommendations based on data analysis.

• Provides analytic consultation to other business areas, leadership, or external customers.

• Data analysis and reporting encompasses a much higher level of complexity.

• Use tools to enable HEDIS to measure deep dives and data quality review to improve HEDIS Ratings.

Minimum Requirements:

• Requires a BS/BA degree in a related field and a minimum of 5 years’ experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, & Experiences:

• Experience with relational databases and knowledge of query tools and statistical software is strongly preferred including SQL and TOAD for Oracle.

• The ability to manipulate large sets of data is strongly preferred.

• Strong analytical, organizational, presentation, and problem-solving skills strongly preferred.

• Excellent training and communication skills preferred.

• Understanding multiple data sources and formats and utilizing multiple data systems to analyze HEDIS results.

• Advanced knowledge of HEDIS specifications, medical record review process including the sample and chase creation, and data analysis of HEDIS rates.

• Experience completing HEDIS measure validations, knowledge of HEDIS software tools, and working with NCQA on HEDIS measure questions.

• Experience testing HEDIS measures and validating HEDIS Results in HEDIS software.

• Ability to articulate complex HEDIS measures.

• Experience working with State and National HEDIS auditors.

• Experience working with NCQA, CMS, and State regulatory agencies; knowledge of NCQA vendors.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $88,480.00 to $159,264 annually.

Locations: California; Colorado; District of Columbia (Washington, DC), Maryland, Nevada; New York; Washington State

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success – for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.