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Ability to meet accreditation and quality standards including, but not limited to NCQA, PCMH, HEDIS through following defined procedures to assess, intervene and document interactions. Ability to meet accreditation and quality standards including, but not limited to NCQA, PCMH, HEDIS through following defined procedures to assess, intervene and document interactions.
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Builds externally facing reporting using HEDIS and other population health quality measures. The Decision Support Analyst II supports the design, development, and implementation of reports, datasets, and dashboards supporting Partner For Kids (PFK) population health, quality improvement and financial reporting work streams.
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Oversee state SMAC (DSNP) contract requirements for regulatory reporting, encounter reporting, quality audits, HEDIS/EPSDT, state relationships for DSNP, and other contract requirements. Ensure county expansion is in alignment with Medicaid growth goals and LTSS strategies.
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Acts as HEDIS champion for the PCP by providing visibility of HEDIS needs for scheduled patients. Acts as HEDIS champion for the PCP by providing visibility of HEDIS needs for scheduled patients.
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Strong understanding of healthcare quality measures, including NCQA HEDIS measures, measures derived from EHR and other standardized datasets, administrative data, and public health databases. Manage the process of NCQA certification for HEDIS measures, including data collection, submission, and validation.
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Knowledge of the Healthcare industry including physician practices, market access, insurance, managed care, organized delivery systems, STARs/HEDIS, Value based care and risk adjustment models. Knowledge of the Healthcare industry including physician practices, market access, insurance, managed care, organized delivery systems, STARs/HEDIS, Value based care and risk adjustment models.
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Design Return on Investment (ROI) Analyses for new Value Based Payments (VBP) using multiple data sources, including prior authorizations, healthcare claims, Admit/Discharge/Transfer (ADT) data, HEDIS data, etc.
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Utilize clinical experience, great communication skills, an understanding of medical practice documentation, as well as knowledge of regulatory requirements for community health centers (i.e. CMS, Meaningful Use, UDS, HEDIS, OSHPD etc.
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