Analyst, Health Plan Risk & Quality Reporting (Remote in FL)

JOB DESCRIPTION Job Summary Provides analyst support for health plan risk and quality reporting activities. Designs and develops custom health plan reports to support local interventions, provider outreach, and tracks outcomes of initiatives. Educates users on how to use reports related to risk and quality/Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid, Medicare, Marketplace and Medicare/Medicare-Medicaid Plan (MMP). Assists with research, development, and completion of special quality performance improvement projects including root-cause analysis. Essential Job Duties • Captures and documents health plan quality reporting requirements, builds custom reports, and educates health plan users on how to use reports. • Builds intervention strategy reporting for the risk and quality interventions and measures gap closure. • Builds ad hoc quality reports as requested to track HEDIS performance and supplemental data monitoring. • Develops quality assurance (QA) custom health plan reports related to Risk and Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP. • Develops custom health plan reports related to managed care data including medical claims, pharmacy, lab and HEDIS rates. • Collaborates with the national risk and quality team on testing of pre-production reporting for assigned health plan. • Calculates and tracks gap closure and intervention outcome reporting for the assigned health plan. • Works in an agile business environment to derive meaningful information out of complex and large organizational data sets through data analysis, data mining, verification, scrubbing, and root-cause analysis. • Conducts root-cause analysis for business data issues. • Analyzes data sets and trends for anomalies, outliers, trend changes, and opportunities, using databricks Structured Query Language (SQL), PowerBi, Microsoft Excel, and techniques to determine significance and relevance. • Assists with research, development and completion of special quali