Hcq Quality Program Analyst

6 days ago


Jakarta, Indonesia Agilon Health Full time

Company:
MDX Hawai'i, Inc.

**Location**:
Remote - HI

Job Title:
HCQ Quality Program Analyst

**Job Description**:
Position Summary:
This position will have the opportunity and responsibility to create project plans as well as collaborate with many other resources to improve processes. This role will be responsible to research opportunities for improvement. Tools utilized will include the electronic and paper health record, claims system, clinical informatics reports, national guidelines, NCQA standards, HEDIS specifications, CMS regulations and other applicable resources.

Essential Job Functions:

- Conducts, studies and analyzes the data and spreadsheets from both Health Plans to evaluate MDX Hawaii’s HEDIS measures, with duties including performing computer-based statistical analysis of data related to the Quality Improvement (QI) program, monitoring and ensuring the validity of data, evaluating reports for accuracy of data, and performing analysis to determine statistically significant trends in the data compared to industry standards and recognized benchmarks.
- Creates process documentation for Star Rating and Quality program activities;
- Analyzes, develops and implements improvement activities to increase compliance rates as measured by nationally standardized benchmarks and definitions that includes identifying preventive care areas with declining or plateauing compliance rates over time including root cause analysis for contributing factors, developing and implementing provider level report cards, educational programs and outreach strategies for providers and members to facilitate compliance and competency with HEDIS guidelines;
- Working with report writers to validate and troubleshoot data in HCC manager, Axis and any other systems.
- Working with provider offices directly to increase compliance rates and practice improvement
- Assists with HEDIS reporting with duties including coordinating and submitting samples to the health plan to ensure quality data, maintaining HEDIS member exclusion data, and working with supplemental data sources such as immunization registries and lab vendors.
- Presents updates and summaries to executive leadership, staff, and other audiences as required.
- Works closely with the Medical Director and other team members to plan and develop clinical quality improvement projects and member and provider engagement activities.
- Integrates Stars activities with HCC risk adjustment initiatives to optimize care improvement opportunities with revenue management.
- Conducts coaching and training as appropriate for physicians, NPs, and other staff to improve the quality of the documentation, collection and coding of members’ health data.
- Performs other duties, as assigned.

Required Qualifications:
Minimum Experience:

- Five years in managed healthcare field or academic equivalent.
- Requires experience with quality improvement, requirements, and regulations or related fields (i.e., NCQA, Medicare, Medicaid, etc.).
- Familiarity with EMR systems or chart reviews preferred.
- Willingness to take full ownership for program success and instill accountability in cross functional teams to achieve corporate goals.

Education/Licensure:

- High School Graduate Required.
- Bachelor of health sciences or medical preferred.
- Current valid Hawai’i State Driver’s License and Proof of Hawaii No-Fault Auto Insurance. Clean driving record as evidenced by a recent driver’s abstract (to be provided by employee).



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