HEDIS Clinical Quality Analyst (Full-time Remote, North Carolina)

The HEDIS Clinical Quality Analyst provides clinical direction, guidance, training, and quality oversight for all things related to the clinical aspect of Healthcare Effectiveness Data and Information Set (HEDIS). This position would oversee abstraction, overreads and quality analysis of HEDIS for both Prospective and Retrospective Seasons to ensure the company complies with the standards set by the National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS). Performs quality improvement activities to monitor/maintain quality of care and compliance with applicable standards/regulations. Performs/coordinates HEDIS data collection, medical record review, and quality improvement activities as indicated.

This position will allow the successful candidate to work full time remote. Candidates who are resident of North Carolina are strongly preferred. Out of state candidates will be considered on a case-by-case basis. Must be available to travel for onsite meetings to the Alliance Home office (Morrisville, NC) or Charlotte office, if needed.

Responsibilities & Duties

Oversight of HEDIS Projects

• Subject matter expert for the National Committee for Quality Assurance (NCQA) HEDIS Measures. (Hybrid, Administrative and ECDS) 
• Review the quality of HEDIS internal processes/plans and for alignment with procedures and/or best practices for supporting the HEDIS Team. 
• Responsible for participating in the development, research, and implementation of HEDIS improvement activities
• Plan implementation of Primary Source Verification (PSV) and Medical Record Review Validation (MRRV) Audits
• Oversees quality of abstraction, quality assurance (QA) and second level QA for HEDIS Hybrid Project and Supplemental Data Audit
• Interpret qualitative and quantitative information to appropriately document findings
• Make recommendations for improvement related to any records reviewed and write reports of findings
• Identify system and/or operational issues hindering the attainment of quality performance standards as defined by NCQA standards, applicable state and Federal laws and regulations
• Motivate and influence staff assigned to the Hybrid and SDVA projects in order to accomplish task(s) successfully, analysis of technical specifications, expertise with NCQA/HEDIS resources
• Identify and escalate situations which may pose quality, compliance, and safety risks that may adversely affect the HEDIS Hybrid Audit or SDVA Audit

Coordinate/Oversees Data Analysis and Quality Intervention and Report on Findings

• Generate monthly/weekly HEDIS Quality reports on measure performance to submit to Directors, Managers, and Supervisors
• Coordinates and oversees all quality management programs and projects ensuring compliance with all applicable regulatory bodies
• Develops/implements quality …