HEDIS Manager - #19503726
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
Responsible for all HEDIS activities in the State of FL: lead all NCQA HEDIS audit activities for both the Medicare and Medicaid lines of business with around 20 submissions to NCQA, and at least 5 to the State of Florida (AHCA); responsible for all internal and external reporting activities derived from the HEDIS reported datasets. Primary duties may include, but are not limited to:
- The HEDIS Manager is responsible for sending and tracking all STAR related activities to improve HEDIS outcomes which include proactive medical record collection activities, provider STAR scores, provider relations representatives STAR scores, and Health Plan STAR scores; responsible for the generation and submission of timely State and CMS regulatory reporting which failure to submit timely reports to the regulatory entities could result in Compliance issues up to civil monetary penalties and low STAR ratings; responsible for IDSS submission, validation, and final accountability of the HEDIS outcomes reported yearly to NCQA and Agency for Healthcare Administration (AHCA).
- Leads and manages annual HEDIS process within plan or region; serves as subject matter expert to enterprise team.
- Identifies, develops, and improves processes, procedures, and operations, conducts analysis, leads cross functional teams, and schedules, develops, and implements initiatives to strategically improve project processes. Secures and coordinates resources, temporary staff, space and equipment, and system requirements.
- Evaluates and monitors performance and efficiency of programs to ensure that implementation meets targeted timelines.
- Develops strategy with multiple enterprise departments and external vendor to annually field a new HEDIS pursuit application.
- Synthesizes performance data, prepares presentation materials, and presents comparative complex reports to local and enterprise quality committees.
- Builds relationships with internal and external customers.
This position will work from the Atlanta, GA, MiamI, FL or Tampa, FL office.
- Requires a BA/BS in public health, nursing or related field; 5+ years of experience involving direct health care background and analyses of health care data, including1+ years of experience with HEDIS activity coordination and experience working with Managed/Acute/ Provider Care environment; or any combination of education and experience, which would provide an equivalent background.
- Masters in Public Health, Health Services Administration, Nursing, or Business Administration preferred. RN, RHIA or RHIT and CPHQ license preferred.
- NCQA and HEDIS experience preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
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