HEDIS User Acceptance Testing SME - Clinical and Quality Solutions
About the position The HEDIS User Acceptance Testing SME - Remote is responsible for providing expertise in the area of HEDIS data testing and analytics. A UAT SME would support multiple payers with their NCQA and state specific submissions related application validations and testing. This position would require providing strategic support driven metrics to improve measures results for the users of Quality Portfolio web applications. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Responsibilities
- User Acceptance Testing of User Interface and Reporting based applications
- Design, draft and execute test cases
- Prepare required input data along with expected results
- 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
- Analyze, review, forecast and trend complex data, review the analysis and interpretation of others' work
- Develop and implement effective/strategic business solutions through research and analysis of data and business processes
- Support short- and long-term operational/strategic business activities through analysis and testing
Requirements
- 3+ years of experience in a health care delivery organization, such as a managed care organization
- 3+ years of HEDIS experience, performing a wide range of functions with strong focus on data analysis
- 3+ years of data analysis experience
- 3+ 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
- Intermediate knowledge of Excel (i.e., VLOOKUPS, Pivot Tables, etc.)
Nice-to-haves
- STARS experience
- 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
- 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
- Familiarity with ICD-9-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding
- Understand basic concepts of CMS Quality Rating System
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
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