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HEDIS Business Information Consultant

Location: This position will work in a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

The HEDIS Business Information Consultant is responsible for serving as an expert in data analysis, reporting and formulating recommendations, and providing guidance to team members and customers. This position is part of the Enterprise HEDIS Implementation Team. It will be responsible for working with management and peers on data ingestion, mapping, transformation, and reporting to support NCQA/CMS and State Medicaid agencies. The position may support multiple contracts inclusive of new market implementations, audits, benchmarking, testing, validation, and process improvement activities with a focus on data quality, accuracy, and completeness.

How You Will Make an Impact :

• Analyzes data and identifies trends and patterns; creates reports that illustrate data findings.

• Develops data quality metrics and standards for different types of data to ensure that it is high quality and error-free; communicates insights and recommendations to stakeholders.

• Creates and publishes periodic reports, as well as any necessary ad hoc reports.

• May require taking business issues and devising the best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.

• Source to target mapping in conformance with software vendor specifications.

• Participates in system integration testing and unit acceptance testing; ensures data loads are error-free and meet data quality standards and user acceptance testing.

• Provides analytic consultation to other business areas, leadership, or external customers.

• Data analysis and reporting encompasses a much higher level of complexity.

Minimum Requirements:

Requires a BS/BA degree in a related field and a minimum of 5 years experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, & Experiences:

• Experience with relational databases and knowledge of query tools and statistical software is strongly preferred including SQL & TOAD for SQL Server & Excel.

• 3-5 years experience querying/analyzing data from multiple platforms and formats highly preferred.

• The ability to manipulate large sets of data is strongly preferred.

• Strong analytical, organizational, presentation, and problem-solving skills strongly preferred.

• Excellent training and communication skills.

• Experience in HEDIS data & analytics preferred.

• Knowledge of healthcare industry standards and experience working with health insurance data such as enrollment, claims, membership, and provider data preferred.

• Experience working with NCQA, CMS, and State regulatory agencies and auditing firms is strongly preferred.