Performance & Quality Analyst

JOB SUMMARY

The Performance and Quality Analyst is responsible for sourcing, normalizing and reporting data related to The Company’s Performance & Quality programs, including risk adjustment, HEDIS, CAHPS and value-based performance measures.  The Analyst works under the direction of industry experts, and independently collects data from various internal and external sources and prepares extracts used by The Company for engagement programs and payor submission.  Additionally, the analyst will publish performance status reports used by The Company leadership to monitor performance against contractual requirements.  The Performance & Quality Analyst will be comfortable speaking both “business” and “data” with our internal teams and external vendors to understand business questions, develop ways to answer those questions, and communicate answers to stakeholders.

This is an onsite position at our headquarters in Doral, Fl.

DUTIES & RESPONSIBILITIES

The Performance and Quality Analyst job description is intended to point out major responsibilities within the role, but it is not limited to these items.

• Collaborate with business stakeholders to understand analytics requirements, develop analytics solutions and deliver reporting insights to improve and monitor company Risk Adjustment & Quality Performance
• Bring together and normalize various sources of complex data, such as HEDIS gap lists, HCC gap lists, plan-specific data and company encounter data
• Reconcile gap lists to identify false gaps and ensure data accuracy
• Stage data for loading into systems like data lakes and EMRs
• Prepare and analyze reports, including HCC & HEDIS gap list summaries, status reports, performance reports (e.g., engagement outcomes), supplemental extracts, and performance metrics
• Reconcile performance against Value-Based Contracts and monitor related metrics, such as RAF and Star ratings
• Create and monitor performance forecasts, such as RAF forecast reports, average RAF, and average Star reports
• Monitor supplemental medical record requests, acquisition, and results
• Oversee HCC coding accuracy from company EMR data to ensure compliance with standards and performance expectations
• Create reporting resources and datasets that are well designed, easily maintained, and repeatable
• Produce clear and concise summaries and presentations of analytical findings for diverse audience
• Other duties and responsibilities as assigned

EDUCATION AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree in finance, economics, business, math or science, or equivalent work experience required
• Three (3) years’ professional healthcare experience in the area of medical economics, analytics, finance or strategy
• Expertise in understanding and reporting on healthcare financial and operational KPIs, including developing financial models
• Strong knowledge of Risk Adjustment models, quality measures and value based arrangements
• Strong knowledge of HEDIS measures
• Understanding of value-based reimbursement principles, reporting and analytics required
• Understanding and experience in working with clinical and operational teams required
• Advanced skills in Microsoft Office Products; Word, Excel, PowerPoint, PowerBI, Visio, SharePoint

PROFESSIONAL COMPETENCIES

• Expertise in analytics, statistics, data visualization, or programming.
• Dedicates exacting attention to detail and data quality.
• Experience with healthcare and consumer data preferred.
• Eager learner, collaborative partner, easy communicator, and careful analyst.
• Passion for empirical research and answering hard questions with data.
• Strong interpersonal, organizational, problem-solving, analytic, communication and presentation skills.
• Ability to adapt to changing business environment and relationships.
• Adept at working independently and in a collaborative team environment.
• Takes an innovative approach to complex problems.
• Results-driven, detail-oriented and understands the big picture.