Peak Health · 4 hours ago
Senior Quality Business Intelligence Engineer
Core, WV
Full-time
Remote
Senior Level
5+ years exp
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Responsibilities
Familiarity with HEDIS, CAHPS, PQA/Pharmacy, HOS, and CMS Display measures and/or other health care quality metrics.
Develop standard reports, tracking tools, metrics to monitor vendor performance, Stars/Quality measures, tactics, and initiatives.
Support the Stars Program strategy, objectives, and initiatives through the creation of reports and/or analysis to drive a year over year 4+ overall Stars rating.
Work with Stars Program leader(s) to develop and execute Stars-focused roadmap that defines the path to operationalize specific actions which are repeatable, measurable, and cost-effective.
Provide subject matter expertise, support, and training, as needed, for both the Quality and Stars programs.
Ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions.
Foster a positive and collaborative work environment, encouraging teamwork and professional growth.
Develop and implement training programs to enhance the skills and knowledge of the team.
Support the development, integration, and maintenance of Stars initiatives. Ensure maximization of initiative for Stars, Quality, and Regulatory requirements.
Ensure compliance with all applicable regulatory requirements, guidelines, and contractual obligations related to Quality, HEDIS, and Stars.
Reconciliation of reporting to ensure accuracy and timely completion.
Prepare and submit reports on Quality, HEDIS, and Stars performance, highlighting key metrics, trends, and areas for improvement.
Must possess current understanding of how compliance and quality programs such as Medicare STARS, HEDIS, and NCQA affect the Plan.
Performs other duties as assigned.
Qualification
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Required
Bachelor’s Degree in Healthcare Administration, Business Administration, Finance, Economics, Information Systems, or a closely related field
Five (5) years of experience in Quality, Stars, Regulatory Reporting or related field within the healthcare industry.
Three (3) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities and quality outcomes.
Strong knowledge of Quality methodologies and reporting/regulatory requirements (e.g., CMS-HCC).
Strong knowledge of CMS Stars Ratings measures including HEDIS, CAHPS, PQA/Pharmacy, HOS, and CMS Display measures.
Proficiency in data integration tools and techniques.
Strong knowledge of database management systems (e.g., SQL, NoSQL), data modeling, ETL processes, and data warehousing concepts.
Experience with data visualization and analytics tools (e.g., SAS Enterprise Guide, SAS Visual Analytics, Tableau, Power BI).
Demonstrated ability to analyze complex data sets, identify patterns, and derive actionable insights.
Exceptional problem-solving and critical-thinking abilities, with a keen attention to detail.
Flexibility to adapt to changing priorities and business needs.
Strong interpersonal and communication skills, both written and verbal, to effectively collaborate with cross-functional stakeholders.
Preferred
Master’s Degree in Healthcare Administration, Business Administration, Finance, Economics, Information Systems, or a closely related field
Three (3) years of experience working with Medicare and/or Medicaid Data
Knowledge of Medicare HEDIS and STARS forecasting
Knowledge of ICD Diagnosis, CPT, UB, HCFA coding and understanding
Understanding of CMS Medicare Regulatory Reporting
Company
Peak Health
Making health care more accessible, understandable, and collaborative.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Ben Gerber
Chief Executive Officer
Brian Stilwell
VP of Finance / CFO
Company data provided by crunchbase
