HEDIS Data SME – Clinical and Quality Solutions – Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

HEDIS Data SME is responsible for providing expertise in the area of HEDIS data analytics. A HEDIS Data SME would support multiple payers with their NCQA and state specific submissions. This position would require providing strategic support and develop data driven metrics to improve measures results.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Manage multiple client priorities 
• Have experience and expertise in SQL
• Be able to read, and write SQL code with knowledge of inner and outer joins, table and view properties, and ability to review and understand a data dictionary as it relates to a database environment
• Understand HEDIS data 
• Have expertise in health plan data; Member, Enrollment, Provider, Lab, Visits, Pharmacy, etc
• Understand Supplemental data concepts for HEDIS
• Understand basic concepts of CMS Quality Rating System
• Experience working in a matrix environment
• Develop data driven metrics to identify gaps and implement interventions to improve results on key performance measures
• Thorough understanding of measure analytics to perform investigative research
• Evaluates and prioritizes recommendations for quality improvement to customers
• Familiarity with ICD-9-CM, ICD-10-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding
• Be able to translate data from various formats and data warehouses
• Be able to merge and append data from various sources
• Experience in Data Validation
• Provide guidance to clients on data issues and data questions
• Knowledge of claims and claims processing
• Demonstrates ability to consistently follow published HEDIS and Stars technical specifications 
• Provide strategic support in preparation of the HEDIS Roadmap, HOQ, HEDIS audit
• Be able to work with ambiguity
• Be able to manage and prioritize large projects with great visibility
• Be able to present to client’s data results via Microsoft Teams
• Intermediate to expert level in MS Office, especially MS Excel for data validation reports and summary rate report compilation of results/edits required, etc.

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:

• 2+ years of experience in a health care delivery organization, such as a managed care organization
• 2+ years of HEDIS experience, performing a wide range of functions with solid focus on data analysis
• 2+ years of data analysis experience
• 2+ years working with final submission files to NCQA, CMS, California P4P, NY QARR, and/or other state submissions
• 1+ years of writing SQL code
• 1+ years of experience working in a matrix environment
• 1+ years of experience on Python and/or Scripting language
• Intermediate knowledge of Excel (i.e., VLOOKUPS, Pivot Tables, etc.)

Preferred Qualifications:

• Experience working with HEDIS software vendors (management, building relationships, issue resolution etc.)
• Experience working with the CAHPS/HOS survey and/or patient satisfaction in care delivery\
• Experienced in medical record review
• Experience working with Alteryx
• STARS experience
• Knowledge of Medicaid and/or Medicare programs
• Knowledgeable of current trends in HEDIS in managed health care
• Knowledge of NCQA, CMS, HOS, and CAHPS requirements
• Understand basic concepts of CMS Quality Rating System
• Familiarity with ICD-9-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.