AmeriHealth Caritas

Supports corporate, plan-level, and departmental strategies and goals for quality measure (HEDIS, CMS Adult / Child Core Set and state-required) reporting process. Meets this standard by effectively applying both business knowledge and technical expertise to support business initiatives and solve business problems.

Essential Functions include but not limited to:

• Supports corporate, plan-level, and departmental strategies and goals for quality measure reporting through processing external data feeds to optimize performance.
• Meets this standard by effectively applying both business knowledge and technical expertise to support business initiatives and solve business problems.
• Generates and maintains thorough and accurate documentation related to data, databases, business rules, and reporting policies and procedures for all lines of business.
• Develops and executes test processes including QA of own work and for QA by team members related to end-user data and databases.
• Develops reports to provide information to stakeholders (Use of SQL, SAS, Tableau)
• Documents and tracks data-related issues and facilitates resolution of such issues.
• Performs analysis of clinical data.
• Develops reports to provide information to stakeholders (use of SQL, SAS SQL, Azure Databricks, Tableau, PowerBI).
• Assists end users in understanding of data.
• Assists with data transformation / standardization activities.
• Works closely with the data warehouse team and others within IS to ensure timely and complete receipt of data from all sources.
• Assesses data within the database for completeness and accuracy.
• In collaboration with IS, tracks file format changes and other template variance. Communicates with data source contact when issues arise.
• Supports efforts to onboard new data feeds and assists with evaluation of new feeds including identification of prioritization
• Participates in investigation of quality measure variance related to clinical data exchanges including analyses and plan-initiated requests
• Actively collaborates with the HEDIS team on longitudinal projects

Education/Experience:

• Bachelor’s Degree required – preferably with a concentration in health care related field, statistics, Information Technology, or mathematics.
• Minimum 1 year HEDIS experience required, 2+ years preferred.
• Minimum 5 years of work experience in healthcare and/or managed care.
• Familiar with standard relational database concepts.
• Strong skills in at least one database query language (SAS, SQL, and/or Python).
• Experience with tableau and / Power BI preferred.
• Familiar with clinical ontologies and code sets: SNOMED, LOINC, ICD, etc. is a plus.
• Background in use of statistical process control techniques, data modeling, and/or data analysis.
• Familiarity with HEDIS and / or CMS Adult / Child Core set technical specifications.
• Familiarity with National Interoperability and Clinical Data Exchange standards including HL7 standards and healthcare related EDI technologies.
• Alignment with the AmeriHealth Caritas mission of helping people get care, stay well and build healthy communities with a special concern for those who are poor.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.