HEDIS Clinical Quality Analyst (Full Time, Remote, North Carolina Based)

The HEDIS Clinical Quality Analyst provides clinical direction, guidance, training, and quality oversight for all things related to the clinical aspect of Healthcare Effectiveness Data and Information Set (HEDIS). This position would oversee abstraction, overreads and quality analysis of HEDIS for both Prospective and Retrospective Seasons to ensure the company complies with the standards set by the National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS). Performs quality improvement activities to monitor/maintain quality of care and compliance with applicable standards/regulations. Performs/coordinates HEDIS data collection, medical record review, and quality improvement activities as indicated. **This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed.** **Responsibilities & Duties** Oversight of HEDIS Projects - Subject matter expert (SME) for the National Committee for Quality Assurance (NCQA) HEDIS Measures. (Hybrid, Administrative and ECDS) - Review the quality of HEDIS internal processes/plans for alignment with procedures and/or best practices for supporting the HEDIS Team. - Responsible for participating in the development, research, and implementation of HEDIS improvement activities - Plan implementation of Primary Source Verification (PSV) and Medical Record Review Validation (MRRV) Audits - Oversees quality of abstraction, quality assurance (QA) and second level QA for HEDIS Hybrid Project and Supplemental Data Audit - Interpret qualitative and quantitative information and appropriately document findings - Make recommendations for improvement related to records reviewed and report findings - Identify system and/or operational issues hindering the attainment of quality performance standards as defined by NCQA, applicable state and Federal laws and regulations - Motivate, influence, and provide direction to staff assigned to the Hybrid and SDVA projects to ensure successful completion of project goals, deliverables, and timelines - Analyze and interpret technical specifications, business requirements, and regulatory guidance to support accurate implementation of HEDIS measures and project activities - Serve as a subject matter expert on NCQA and HEDIS resources, providing guidance, training, and consultation to project teams - Identify and escalate situations which may pose quality, compliance, and/or safety risks that may adversely affect the HEDIS Hybrid Audit, HEDIS Prospective Audit or SDVA Audit Coordinate/Oversees Data Analysis and Quality Intervention and Report on Findings - Generate monthly/weekly HEDIS Quality reports on measure performance and submit to Directors, Managers, and Supervisors - Coordinates and oversees all quality management programs/projects ensuring compliance with all applicable regulatory bodies - Develops and implements quality management and error reduction programs as needed - Provide written feedback to Directors, Managers and Supervisors concerning quality concerns pertaining to individual performance, compliance risks/trends, root cause analysis and any system or process improvements recommendations related to the NCQA HEDIS measures Effectively Measure the Key Output Variables to Ensure All Performance Changes are Accurately Assessed - Prepare analysis of initial and repeat HEDIS measures to evaluate efficacy of interventions and to improve approach for successfully resolving the root cause as needed - Evaluate validity and accuracy of supplemental data sources to draw appropriate conclusions Analyze Changes in Performance to Determine the Impacts of Interventions - Perform any required data analysis to evaluate gaps in care - Prepare comprehensive reports to ensure adequate documentation and methodology to support findings and recommenda…