Job details
Job type full-time
Full job description
This key role will be responsible for analyzing operational processes to drive quality improvement throughout the operationThe operations quality analyst is responsible for defining, managing, verifying, and reporting key quality kpis/metrics for various aspects of the businessThese metrics will help drive business functions and identify key areas for process improvementThe analyst will coordinate data collection and reports of various operations function to ensure they are accurate and compliant with relevant law, regulations, process and proceduresIdeal candidates will maintain a broad knowledge of corporate claims processing, enrollment, government programs, regulations and regulatory guidelines for use in conducting quality control, quality assurance and operational improvementMajor focus on the role will include creation of data visualizations, reports, and dashboards for internal and external use.
Key functions/responsibilities:
Review and manipulate data and reports from multiple sources
Design and maintain databases, data reports, and dashboards for tracking and reporting of quality.
Develop functional and technical specifications for data extracts to be used for data analysis and reporting
Collaborate closely with sql programmers to interpret, define, and document data extraction specifications
Develop easy-to-understand charts, tables, and graph for diverse audiences.
Monitor and quickly address audits and data issues as they arise; escalate issues and support resolution in collaboration with the manager of quality assurance.
Incorporate quality improvement methods via all data dashboards and presentations
Collaborate with other departments in order to interpret and assess needs of data requests.
Ensure the quality and timeliness of assigned deliverables; manage multiple concurrent projects.
Detail oriented with an understanding of quality improvement processes and related data skills
Participate in the development and implementation of efficient and effective qa methodology including test automation, processes, procedures, templates guidelines and tools.
Determine root cause for data quality and make recommendations for long-term solutions.
Develop and maintain quality assurance process and procedure documentation and job aids to ensure consistent findings and determinations
Qualifications:
Education :
High school diploma or ged required
Education preferred/desirable:
Bachelor degree or higher
Experience with cms auditing, star ratings and cahps surveys
Experience with data reporting and analytics
Sql
Experience:
5+ years in an hmo or other managed care setting, with experience on medicare products such as a medicare advantage plan, sco or duals plan a plus
Working knowledge of healthcare operations and claims and enrollment processing
Call center or customer service quality monitoring knowledge and quality improvement concepts, practices and procedures
Experience preferred/desirable:
Project management
Prior experience within an hmo, ppo or other health plan
Prior experience within a medicare advantage, ffs, or other, organization and/or a medicaid managed care organization
Prior experience evaluating and managing vendor quality
Experience with cms stars ratings and cahps surveys
Experience with data reporting and analytics
Certification or conditions of employment:
Quality certification preferred (cphq, cqe, cqa, etc.)
Competencies, skills, and attributes:
Knowledge of medicare regulations
Effective collaborative and proven process improvement skills
Strong oral and written communication skills; ability to interact within all levels of the organization.
A strong working knowledge of microsoft office products
Demonstrated ability to successfully plan, organize and manage projects
Demonstrates strong organization skills and ability to work in a rapidly changing environment
Familiarity with government programs such as medicare and/or medicaid
Claims or other experience using industry standard coding
Experience applying analytical results to decision-making
Excellent team player with strong leadership skills
Must be able to effectively manage activities across multiple departments
Requires the capacity to clearly communicate complex issues and problems and escalate effectively
Detail oriented, excellent writing, proof reading and editing skills required
Ability to build and lead effective teams
Ability to work independently and collaboratively, manage multiple projects and meet scheduled deadlines
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Required skills
Required experience
