At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start
Caring. Connecting. Growing together.
Our Quality Reporting Operations team is vital to our success and driving the future growth of UnitedHealth Group. Success in these careers relies on many factors - your ability to deal with ambiguity, your ability to adapt and embrace change, and a long-term commitment to making health care better for everyone.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Facilitate, oversee and monitor on-going business processes to support HEDIS data reporting
Monitor compliance against relevant process requirements (e.g., turnaround time, accuracy)
Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state
Ensure all business requirements are met
Demonstrate understanding of relevant organizations' operations, products and applications, strategies, processes, and/or business priorities in order to build effective solutions including development of project plans (e.g., communication plans; implementation steps) to support operations using relevant tools and databases
Submission of the NCQA Health plan Roadmap General Information, Appendix and Attestation
Submission of the NCQA Healthcare Organization Questionnaire (HOQ)
Complete admin and hybrid measure benchmarking and rate review to resolve all CHCA (Auditor) rate outlier concerns throughout the HEDIS project (Initial, Refresh, Final) on complex projects
Perform SDS, administrative refresh data loads and vendor medical record event data loads to the hybrid project and update rates
Perform all MRR project build steps, including QA, to ensure each hybrid MRR project is set up according to business requirements
Coordinate with medical record vendors on file loads and resolving technical project issues
Confirmation of all hybrid exclusions entered into HEDIS software, coordinating clinical review when necessary
Complete all HEDIS software upgrade steps as required
Create and validate all final hybrid frozen counts and deliver to CHCA
Complete all final hybrid project close steps, including validation of all exclusions and QA of all final data and rates
Complete all final admin and hybrid project processing
Creation of IDSS exports and submission to NCQA
Creation of PLD exports and submission to CHCA and/or CMS
Submission of State required reporting if applicable
Coordinate efforts with the LOB Operations team to ensure all business requirements and deliverables are met
May also assist in supporting chase status updates, chase activations, query exports and special request data analysis or validation
Monitor and analyze business process information (e.g., metrics; analytics) to identify key issues, trends, and potential root causes (e.g., training issues; lack of understanding by user community) that point to improvement opportunities
Participate in analysis of project outcomes to generate data driven recommendations for process improvement
Lead and participate in workgroups to implement process improvement and/or in preparation to meet business requirements
Participate in HEDIS software system testing efforts to ensure project preparedness
Use a process driven approach to identify root cause and process improvement opportunities
Demonstrate and remain current in understanding of relevant regulations and systems
Complete all required training for job role and stay current on all HEDIS technical specifications and software systems
Develop proficiency in HEDIS software tools and HEDIS and other required quality metric reporting specifications
General knowledge of HEDIS impacts for each LOB, i.e. Accreditation, STARs, FEHB, State, etc.
Summarize and communicate proposed solutions with the appropriate audiences
Resolve all CHCA (Auditor) Issue Log concerns for projects assigned
Communicate potential impacts and risks associated with implementing proposed solutions to business partners and relevant stakeholders
Timely escalation of all issues and barriers to Manager, QSD Projects (MQP)
Assesses and interprets customer needs and requirements
Identifies solutions to non-standard requests and problems
Solves moderately complex problems and/or conducts moderately complex analyses
Works with minimal guidance; seeks guidance on only the most complex tasks
Translates concepts into practice
Provides explanations and information to others on difficult issues
Coaches, provides feedback, and guides others
Acts as a resource for others with less experience
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
3+ years of experience in analysis and reporting
2+ years HEDIS or CMS stars experience
Experience interpreting and analyzing large amounts of data from multiple sources
Healthcare experience
Intermediate proficiency in MS Excel
Proven excellent communication, time/project management, problem solving, organizational, and analytical skills
Demonstrated ability to manage and prioritize deliverables
Preferred Qualifications:
Experience creating reports
Proficient in use of certified HEDIS software
Advanced proficiency in MS Excel
Soft Skills:
Ability to work without a lot of direction
Team player
Solid communication skills
Organized
Ability to manage multiple projects at a time
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New York, New Jersey, Rhode Island, or Washington Residents Only:
The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group 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). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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