Analyst, Quality Improvement

Evolent Health, Inc. Louisville , KY 40202

Posted 3 months ago

It's Time For A ChangeYour Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely56.7% in year-over-year revenue growth in 2016. Are we recognized? Definitely. We have been named one of "Becker's 150 Great Places to Work in Healthcare" in 2016 and 2017, and one of the "50 Great Places to Work" in 2017 by Washingtonian, and our CEO was number one on Glassdoor's 2015 Highest-Rated CEOs for Small and Medium Companies. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it.

What You'll Be Doing:

This position is responsible for ensuring data integrity, collecting data and providing analysis for a broad array of issues.

  • Works closely with cross-functional development teams within a Medicaid/Medicare payor environment to help establish and maintain data analysis, reporting, and consulting within a quality improvement team.

  • Aggressively identifies potential data quality opportunities related to HEDIS and quality data

  • Develops/drives HEDIS and quality tracking and reporting mechanisms to monitor activities.

  • Design and document workflow and make appropriate recommendations that will positively impact operational effectiveness.

  • Serves as an internal consultant and subject matter expert on Medicaid/Medicare projects and business initiatives that require knowledge of HEDIS measures, health plan accreditation requirements, claims processing system, telephonic systems, member and provider satisfaction measures, and plan wide operational processes.

  • Knowledge of a variety of data reporting systems related to HEDIS and quality reporting/data analysis.

  • Analyzes rework to determine root cause.

  • Fulfills ad hoc data analysis requests; devise and maintain various data mining studies

  • Performs analysis of processes, procedures, and identifies areas for improvement.

  • Investigate, develop and present issue resolution recommendations for system and/or billing issues resulting in incorrect contract administration.

  • Implements interventions and measures their effectiveness.

  • Drives change by use of statistical methods and data analysis with the purpose of identifying financial and non-financial impact to the plan.

  • Coordinates quality reports to submit to DMS/CMS.

  • Reports data for financial impact.

  • Provides daily, weekly, monthly unit statistics to senior leadership.

  • Provides and communicates monthly and quarterly reports to DMS.

  • Provides quarterly QI and QSC reports.

  • Perform other duties and projects as assigned.

The Experience You'll Need (Required):

Education, Training and Experience:

  • Bachelor's degree preferred.

  • Proficiency in standard query language and relational databases

  • Minimum of 2 -3 years health plan (Medicaid/Medicare) quality experience.

  • Minimum of 2 -3 years claims experience preferred.

  • Minimum of 1 -2 years HEDIS experience preferred.

  • Knowledge of claims processing system preferred.

  • Knowledge of Medicare/Medicaid reimbursement methodologies preferred.

  • 1-2 years of experience as a Provider Claims Services Business Analyst or comparable experience preferred.

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

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Analyst, Quality Improvement

Evolent Health, Inc.