Develop and maintain knowledge of measure specific inclusion and exclusion criteria for assigned Healthcare Effectiveness Data and Information Set (HEDIS) measure sets including: preventive screenings, disease management, and utilization management
Develop and maintain knowledge of key performance indicators related to Medicare risk adjustment and Hierarchical Condition Categories (HCCs)
Create ad hoc reports and queries
Effectively visualize and communicate the story in the data
Conduct quality control audits to ensure accuracy of data
Identify, correct, and/or assist in resolution of data quality errors
Collaborate with the utilization management and quality groups to participate in internal reliability studies
Collaborate with clinical coding educators and data abstractors to identify opportunities and provider and clinic education
Perform data scrubbing, trouble-shooting, quality checking, and usability analysis to identify anomalies, which need to be addressed prior to delivery of analytic results
Assist in problem solving and formulation of performance improvement strategies related to compliance with measurement specifications
Other duties as assigned
What You'll Do
Develop and maintain knowledge of measure specific inclusion and exclusion criteria for assigned Healthcare Effectiveness Data and Information Set (HEDIS) measure sets including: preventive screenings, disease management, and utilization management
Develop and maintain knowledge of key performance indicators related to Medicare risk adjustment and Hierarchical Condition Categories (HCCs)
Create ad hoc reports and queries
Effectively visualize and communicate the story in the data
Conduct quality control audits to ensure accuracy of data
Identify, correct, and/or assist in resolution of data quality errors
