Enable America Jobs

Employment Type:

Full time

Shift:

Description:

Why MediGold?

MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing.

What we offer:

• Competitive compensation and benefits packages including medical, dental, and vision coverage

• Retirement savings account with employer match starting on day one

• Generous paid time off programs

• Employee recognition incentive program

• Tuition/professional development reimbursement

• Relocation assistance (geographic restrictions apply)

• Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing

Why Columbus?

The nation's 14th largest city, Columbus, Ohio is one of the fastest growing major metropolitan areas in the Midwest – ranked #1 for population growth, #1 for job growth, #1 for wage growth, and #1 real estate market. And with a vibrant blend of professional sports, world-class attractions, creative cuisines, and a flourishing music and arts scene, you'll never be found wanting for entertainment and experiences to call your own in Columbus. Learn more at www.experiencecolumbus.com !

About the job:

The Analyst is responsible for assisting the department with data collection, verification, integration and reporting.

What you'll do:

• Responsible for overall quality of input and output from the plan’s data system for both internal and external use. Seeks out external information sources and establishes normative/comparative data for use in meeting MCHP's strategic initiatives while assisting with health plan scorecards, quality analytic applications and models.

• Analyzes the effectiveness, efficiency, and the quality of services delivered, developing and implementing plans for clinical information systems projects, including maintenance, improvement, and conducting evaluation of systems.

• Manages the annual Healthcare Effectiveness Data and Information Set (HEDIS) audit and submission.

What we're looking for :

• Education: Bachelor’s Degree in Health related field or equivalent experience, statistics, Finance or data related field required; Master’s in Informatics preferred.

• Experience: 5-7 years relevant experience in analytics and reporting required.

• Advanced understanding of computerized data collection and reporting processes including experience working with Standardized data file formats and interoperability standards (CCDA, JSON, FHIR etc.)

• Technically sophisticated with relational database concepts and applications, analytic data development (statistics) and decision support tools.

• Proficiency with database management, specifically Microsoft SQL server with a strong focus on data integration and interoperability

• Proven ability to work independently as well as in a team, with attention to accuracy and consistency of information obtained and reported.

• Advanced knowledge of Microsoft Office suite of products (Outlook, Word, Power Point, Excel, Access), Tableau and process map development software.

• Ability to analyze and report data and provide insight on business process enhancements.

• Project management skills and demonstrated ability to manage multiple projects/priorities and adhere to aggressive timelines.

• Knowledge of medical terminology including various coding universes (ICD10, HCPCs, CPT, SNOMED.

• Ability to present effectively and technically, in writing and orally, to management, health professionals, physicians and other contracted providers.

• Ability to perform multiple and diverse tasks, readily accept change, and influence organizational change where appropriate.

• Ability to review various internal reports and data sets, analyze and interpret the data, report the results to stakeholders and take the appropriate actions.

• Innovative and self-directed, with the ability to work in cross-functional team environment.

• Extensive knowledge of Performance improvement methods, including control and run charts.

• Experience interacting with health system partners in the context of value-based quality, gain sharing and risk sharing agreements.

• Familiarity with electronic medical records systems such as EPIC, including data processing for quality gap closures.

• Previous experience with HEDIS, CAHPS and Medicare Advantage Star ratings, including technical specifications, eligibility, timeframe and audit protocols.

Essential Responsibilities

• Exhibits each of the Mount Carmel Service Excellence Behavior Standards holding self and others accountable and role modeling excellence for all to see. For example: demonstrates friendliness and courtesy, effective communication creates a professional environment and provides first class service.

• Meets population specific and all other competencies according to department requirements.

• Promotes a Culture of Safety by adhering to policy, procedures and plans that are in place to prevent workplace injury, violence or adverse outcome to associates and patients.

• Relationship-based Care: Creates a caring and healing environment that keeps the patient and family at the center of care throughout their experience at Mount Carmel following the principles of our interdisciplinary care delivery system.

• (For patient care providers) Provides nursing care, ensures an environment of patient safety, promotes evidence-based practice and quality initiatives and exhibits professionalism in nursing practice within the model of the ANCC Magnet Recognition Program®.

• Works directly with Quality Department, Medical Management and Information Systems to develop and request various reports.

• Continuously monitors and analyzes data collection process and creates action plans for data integrity issues found.

• Works directly with Information Systems during implementation of clinical information system projects for population management.

• Creates and maintains advanced-level Tableau dashboards for internal and external users and managing security, access and training

• Performs audits on the integrity of data within various plan systems.

• Creates useful reports using data sets, verifying programming logic, and validating accuracy, including dashboards for reporting performance metrics for external business partners and providers.

• Lead staff in developing a functional internal data integrity program and educating Plan staff, working closely with senior level management support to maintain and implement programs.

• Provide management and technical support of external review of provider data, which meets HCFA’s requirements as well as NCQA’s for HEDIS data integrity requirements.

• Determines the methodology to be used in designing a study.

• Participates in the evaluation of clinical, cost and quality outcomes through statistical analysis and graphic display.

• Provides analysis for Process Improvement groups.

• Designer and keeper of health plan scorecards and medical cost/quality analytic applications and models.

• Continually evaluates effectiveness of reports and benchmarks and provides recommendations for modifications as needed.

• Performs ad hoc analysis in support of report needs.

• Effectively engages in report writing and data display activities.

• Assists in development and documentation of file exchange process flows.

• Serves as a resource and coach for use of data integrity concepts and tools.

• Acts as the primary liaison between Medical Management and Quality Initiatives.

• Liaison with Information Systems support assisting in setting priorities, reporting needs and decision support tools/methods.

• Responsible for designing report requests, managing data collection and report analysis on all Quality Improvement activities such as member health outcomes and provider activities.

• Measure interventions and process changes that improve outcomes.

• Responsible for HEDIS data collection, project coordination and reporting by required deadline. Serves as the liaison for external and internal partners involved in the project to produce valid HEDIS rates for public reporting.

• Responsible for working with legal counsel to obtain required vendor contracts for HEDIS production software, medical record review and auditor.

• Liaison with provider offices in areas of chart record keeping, data collection and associated education with provider relations staff.

• Responsible for developing and updating QM related policy and procedures according to regulatory requirements.

• Other duties as assigned

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran