Hedis Admin Jobs (NOW HIRING)

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

Our Quality Reporting Operations team is vital to our success and driving the future growth of UnitedHealth Group. Success in these careers relies on many factors - your ability to deal with ambiguity, your ability to adapt and embrace change, and a long-term commitment to making health care better for everyone.

You'll enjoy the flexibility to work telecommute * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Facilitate, oversee and monitor on-going business processes to support HEDIS data reporting
  • Monitor compliance against relevant process requirements (e.g., turnaround time, accuracy)
  • Evaluate processes and outcomes against benchmarks and metrics and identify potential business impacts of current state
  • Ensure all business requirements are met
• Demonstrate understanding of relevant organizations' operations, products and applications, strategies, processes, and/or business priorities to build effective solutions including development of project plans (e.g., communication plans; implementation steps) to support operations using relevant tools and databases
  • Submission of the NCQA Health plan Roadmap General Information, Appendix and Attestation
  • Submission of the NCQA Healthcare Organization Questionnaire (HOQ)
  • Complete admin and hybrid measure benchmarking and rate review to resolve all CHCA (Auditor) rate outlier concerns throughout the HEDIS project (Initial, Refresh, Final) on complex projects
  • Perform SDS, administrative refresh data loads and vendor medical record event data loads to the hybrid project and update rates
  • Perform all MRR project build steps, including QA, to ensure each hybrid MRR project is set up according to business requirements
  • Coordinate with medical record vendors on file loads and resolving technical project issues
  • Confirmation of all hybrid exclusions entered into HEDIS software, coordinating clinical review when necessary
  • Complete all HEDIS software upgrade steps as required
  • Create and validate all final hybrid frozen counts and deliver to CHCA
  • Complete all final hybrid project close steps, including validation of all exclusions and QA of all final data and rates
  • Complete all final admin and hybrid project processing
  • Creation of IDSS exports and submission to NCQA
  • Creation of PLD exports and submission to CHCA and/or CMS
  • Submission of State required reporting if applicable
  • Coordinate efforts with the LOB Operations team to ensure all business requirements and deliverables are met
  • May also assist in supporting chase status updates, chase activations, query exports and special request data analysis or validation
• Monitor and analyze business process information (e.g., metrics; analytics) to identify key issues, trends, and potential root causes (e.g., training issues; lack of understanding by user community) that point to improvement opportunities
  • Participate in analysis of project outcomes to generate data driven recommendations for process improvement
  • Lead and participate in workgroups to implement process improvement and/or in preparation to meet business requirements
  • Participate in HEDIS software system testing efforts to ensure project preparedness
  • Use a process driven approach to identify root cause and process improvement opportunities
• Demonstrate and remain current in understanding of relevant regulations and systems
  • Complete all required training for job role and stay current on all HEDIS technical specifications and software systems
  • Develop proficiency in HEDIS software tools and HEDIS and other required quality metric reporting specifications
  • General knowledge of HEDIS impacts for each LOB, i.e. Accreditation, STARs, FEHB, State, etc.
• Summarize and communicate proposed solutions with the appropriate audiences
  • Resolve all CHCA (Auditor) Issue Log concerns for projects assigned
• Communicate potential impacts and risks associated with implementing proposed solutions to business partners and relevant stakeholders
  • Timely escalation of all issues and barriers to Manager, QOI Projects (MQP)
• Assesses and interprets customer needs and requirements
• Identifies solutions to non-standard requests and problems
• Solves moderately complex problems and/or conducts moderately complex analyses
• Works with minimal guidance; seeks guidance on only the most complex tasks
• Translates concepts into practice
• Provides explanations and information to others on difficult issues
• Coaches, provides feedback, and guides others
• Acts as a resource for others with less experience

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

Required Qualifications:

• High School Diploma/GED
• 3 years of experience in analysis and reporting
• 3 years of experience interpreting and analyzing large amounts of data from multiple sources
• 2 years of HEDIS or CMS stars experience
• 2 years of healthcare experience
• Intermediate level of proficiency in MS Excel

Preferred Qualifications:

• Experience creating reports
• Proficient in use of certified HEDIS software
• Advanced proficiency in MS Excel

Soft Skills:

• Proven excellent communication, time/project management, problem solving, organizational, and analytical skills
• Demonstrated ability to manage and prioritize deliverables

Competencies

• Integrity Value: Act Ethically
  • Comply with Applicable Laws, Regulations and Policies
  • Demonstrate Integrity
• Compassion Value: Focus on Customers
  • Identify and Exceed Customer Expectations
  • Improve the Customer Experience
• Relationships Value: Act as a Team Player
• Collaborate with Others
  • Demonstrate Diversity Awareness
  • Learn and Develop
• Relationships Value: Communicate Effectively
  • Influence Others
  • Listen Actively
  • Speak and Write Clearly
• Innovation Value: Support Change and Innovation
  • Contribute Innovative Ideas
  • Work Effectively in a Changing Environment
• Performance Value: Make Fact-Based Decisions
  • Apply Business Knowledge
  • Use Sound Judgement
• Performance Value: Deliver Quality Results
  • Drive for Results
  • Manage Time Effectively
  • Produce High-Quality Work

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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