Medical Mutual employees must submit their applications through MySource.
This role is fully remote, and we are targeting candidates who reside in Ohio.
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
HEDIS Quality Improvement Analyst I
Job Summary:
Supports corporate and departmental strategies and goals in alignment with regulatory specifications for the annual Healthcare Effectiveness Data and Information Set (HEDIS) lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS). Supports data capture and reporting of clinical quality of care received by members. Works closely with the Quality team to support strategies to improve quality of care received by members, and members' health outcomes.
Responsibilities:
- Coordinates and collaborates interdepartmentally to produce the annual HEDIS Roadmap. To include data documentation, compilation, reconciliation, and research.
- Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies, and operating procedures. Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
- Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures. Collaboratively reviews mapping documentation for annual HEDIS Specification update application and coordinates implementation.
- Supports interdepartmental and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of medical records. Works closely with HEDIS vendor support to ensure data integrity and chart collection.
- Produces routine HEDIS reporting to support clinical Quality initiatives to improve member health.
- Participates in required trainings and performs other duties as assigned.
Qualifications:
Education and Experience:
- Bachelor’s Degree in health care administration, public health, or a related field.
- Analytical or project experience in health administration or government programs preferred.
Professional Certification(s):
Technical Skills and Knowledge:
- Basic to intermediate proficiency in database reporting (SQL) and analytics programming languages (SAS).
- Foundational knowledge of health insurance industry.
- Foundational knowledge of project management.
- Ability to draft analytical assessments and summarizing content in simplified language.
HEDIS Quality Improvement Analyst II
Job Summary:
Supports corporate and departmental strategies and goals in alignment with regulatory specification for the annual Healthcare Effectiveness Data and Information Set (HEDIS) lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS). Supports data capture and reporting of clinical quality of care received by members. Works closely with the Quality team to support strategies to improve quality of care received by members, and members' health outcomes.
Responsibilities:
- Coordinates and collaborates interdepartmentally to produce the annual HEDIS Roadmap. To include data documentation, compilation, reconciliation, and research. Works directly external HEDIS/NCQA auditor to resolve any items on Issue Log.
- Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies and operating procedures. Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
- Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures. Collaboratively reviews mapping documentation and builds updated requirements for annual HEDIS Specification application and coordinates implementation.
- Supports interdepartmental and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of medical records. Works closely with HEDIS vendor support to ensure data integrity and chart collection.
- Produces routine to moderately complex HEDIS reporting to support clinical Quality initiatives to improve member health.
- Orients and trains more junior-level Analyst
- Participates in required trainings and performs other duties as assigned.
Qualifications:
Education and Experience:
- Bachelors Degree in health care administration, public health, or a related field.
- 2 years experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience.
Professional Certification(s):
Technical Skills and Knowledge:
- Knowledge of health insurance industry.
- Knowledge of project management.
- Ability to draft analytical assessments and summarize content in simplified language.
- Ability to execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.
- Intermediate proficiency in database reporting (SQL) and analytics programming languages (SAS).
HEDIS Quality Improvement Analyst III
Job Summary:
Produces reporting and analyses to identify actionable opportunities for quality improvement across all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid). Integrates diverse data sources to report performance on key quality indicators, including but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), STARS, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Healthcare Outcomes Survey (HOS). Conducts in-depth analyses to target potential interventions or initiatives to improve health plan members quality of care. Supports quality improvement initiatives by collaborating with more senior Analysts and management. Consults with and informs business stakeholders of trends, opportunities and risks.
Responsibilities:
- Provides analytical and technical support for the design, development, maintenance, and evaluation of quality improvement initiatives for members and/or providers. Produces in depth, and customized trend reporting across multiple systems and delivers recommendations to improve quality metrics. Collaborates with multiple departments to support performance improvement interventions and initiatives directed to members and/or providers.
- Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies and operating procedures. Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
- Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures. Collaboratively reviews mapping documentation and builds updated requirements for annual HEDIS Specification application and coordinates implementation.
- Supports HEDIS submission lifecycle processes such as data compilation, reconciliation, research, and documentation.
- Supports interdepartmental and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of medical records. Works closely with HEDIS vendor support to ensure data integrity and chart collection.
- Orients, trains and assists more junior-level Analysts.
- Participates in required training and performs other duties as assigned.
Qualifications:
Education and Experience:
- Bachelors Degree in health care administration, public health, or related field.
- 3 years experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience. programs
Professional Certification(s):
Technical Skills and Knowledge:
- Ability to identify opportunities and propose solutions.
- Ability to develop and produce complex reports and dashboards.
- Ability to draft analytical assessments and summarize content in simplified language.
- Ability to design and execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.
- Advanced knowledge of health insurance industry and health plan operations.
- Ability to utilize certified HEDIS software.
- Ability to analyze clinical, claims, pharmacy, encounter, and quality measurement data.
- Advanced knowledge of NCQA and CMS measurement requirements and quality rating systems.
- Advanced proficiency in database reporting (SQL) and analytics programming languages (SAS) and data visualization tools such as Tableau.
Sr HEDIS Quality Improvement Analyst
Job Summary:
Develops reporting and analyses to identify actionable opportunities for quality improvement across all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid). Integrates diverse data sources to report performance on key quality indicators, including but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), STARS, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Healthcare Outcomes Survey (HOS). Conducts in-depth analyses to target potential interventions or initiatives to improve health plan members quality of care. Supports quality improvement initiatives by collaborating with management. Consults with and informs business stakeholders of trends, opportunities and risks.
Responsibilities:
- Leads analytical and technical support for the design, development, maintenance, and evaluation of quality improvement initiatives for members and/or providers. Leads production of in depth, and customized trend reporting across multiple systems and delivers recommendations to improve quality metrics. Collaborates with multiple departments to support performance improvement interventions and initiatives directed to members and/or providers.
- Reviews data sources to ensure accuracy and validity in compliance with HEDIS technical specifications, policies and operating procedures. Identifies, researches, and collaboratively resolves data issues and supports implementation of data improvements.
- Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures. Leads collaborative review of mapping documentation for annual HEDIS Specification update application and coordinates implementation
- Orients, assists, trains, mentors, coaches and reviews work of more junior-level Analyst. May supervise staff in absence of Manager
- Supports HEDIS submission lifecycle processes such as data compilation, reconciliation, research, and documentation
- Supports interdepartmental and vendor project planning coordination and facilitation. Works with IT and Clinical Nurse staff to aid in the loading of HEDIS data and collection of medical records. Works closely with HEDIS vendor support to ensure data integrity and chart collection.
- Participates in required training and performs other duties as assigned.
Qualifications:
Education and Experience:
- Bachelors Degree in health care administration, public health, or related field
- Master’s degree (MBA, MPH, or MHA) preferred
- 5 years progressive experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience
Professional Certification(s):
Technical Skills and Knowledge:
- Ability in identify opportunities and propose solutions.
- Ability to develop and produce complex reports and dashboards.
- Ability to draft analytical assessments and summarize content in simplified language.
- Ability to design and execute analyses to evaluate the effectiveness of interventions and initiatives to improve quality.
- Advanced knowledge of health insurance industry and health plan operations.
- Advanced proficiency in database reporting and data visualization tools including SQL, SAS, DataBricks, Python, and Tableau, and PowerBI.
- Ability to utilize certified HEDIS software.
- Ability to analyze clinical, claims, pharmacy, encounter, and quality measurement data.
- Advanced knowledge of NCQA and CMS measurement requirements and quality rating systems.
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
A Great Place to Work:
- We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
- Employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
- On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
- Discounts at many places in and around town, just for being a Medical Mutual team member.
- The opportunity to earn cash rewards for shopping with our customers.
- Business casual attire, including jeans.
Excellent Benefits and Compensation:
- Employee bonus program.
- 401(k) with company match up to 4% and an additional company contribution.
- Health Savings Account with a company matching contribution.
- Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
- Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
- Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
- After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
An Investment in You:
- Career development programs and classes.
- Mentoring and coaching to help you advance in your career.
- Tuition reimbursement up to $5,250 per year, the IRS maximum.
- Diverse, inclusive and welcoming culture with Business Resource Groups.
About Medical Mutual:
Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.