AmeriHealth Caritas Manager HEDIS Reporting in Philadelphia, Pennsylvania

Manager HEDIS Reporting

Location: Philadelphia, PA

Telecommuter?: Yes

ID**: 16259

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .

Responsibilities:

Manages Healthcare Effectiveness Data and Information Set (HEDIS) planning, data collection, quality control, analysis, and reporting to meet all requirements of National Committee for Quality Assurance (NCQA) and regulatory. Applying both business knowledge and technical expertise to supports HEDIS strategies, goals, and initiatives at corporate and plan-level.

Essential Functions include but not limited:

  • Leads staff in all aspects of HEDIS operations required to meet NCQA submission requirements.

  • Manages HEDIS/CAHPS auditing process including preparation of HEDIS Road Map and all other documents required by auditors.

  • Ensures all data sent to HEDIS software vendor are accurate and meet HEDIS reporting timeline.

  • Develops and manages annual HEDIS project plan and the appropriate protocols of “chase logic.”

  • Manages and ensures HEDIS medical records data abstraction is completed in a timely and accurate manner per NCQA specifications

  • Ensures all HEDIS supplemental data sources are gathered and are completed

  • Improves HEDIS reporting process by leading a “lessons learned” process for internal operational improvement

  • Serves as a team member for activities focused on HEDIS performance improvement.

  • Analyzes HEDIS results and identifies HEDIS performance improvement opportunities.

  • Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect

  • Other duties as assigned with or without accommodation

Management Responsibility

  • Hires, participates in and/or recommends development measures and disciplinary actions up to and including termination, evaluates performance, and supervises the work of all direct and indirect reports following established organizational policies, procedures, and practices.

  • Motivates and encourages staff; leads through change and adversity. Makes decisions as needed and builds consensus as appropriate. Communicates and cascades information to employees in a timely manner and actively participates in the success of cross-organizational programs and initiatives.

  • Sets clear goals and objectives and uses metrics to measure performance and hold staff accountable. Provides coaching to improve performance and holds regular development discussions with direct reports. Recognizes staff for their contribution.

Education/Experience:

  • Bachelor’s Degree in HealthCare related degree required

  • Master’s Degree preferred in Public Health or Business Management

  • Minimum 5 years of working experience in the health care industry.

  • Minimum 2 years of HEDIS project management and data collection experience required.

  • Experience managing a team of Analysts is required

  • Experience using a certified HEDIS vendor tool

  • SQL and / or SAS experience preferred

  • Extensive knowledge of Microsoft Office.

  • Ability to manage multiple, complex projects with strict deadlines.

  • Excellent verbal and written communication skills.

EOE Minorities/Females/Protected Veterans/Disabled