HEDIS Principal Analyst in Southfield, MI at Accident Fund Holdings, Inc

Date Posted: 9/25/2020

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Job Description

This is a REMOTE position and can be located across the U.S.


The Principal Analyst is responsible for planning, organizing, directing, implementing, and leading department assignments related to HEDIS audit, medical record review, and client management. This position operates within broad objectives to ensure optimum utilization of manpower and budget. This role researches, compiles, and analyzes appropriate and relevant data to identify opportunities to recommend and drive execution of process efficiencies in assigned business units to achieve targeted levels of improvement in key operational performance metrics.


  1. Responsible for the oversight and execution of multiple concurrent projects/programs that encompass HEDIS audit, supplemental data and medical record review processes and improvement.
  2. Supports various initiatives in requirements definition, documentation of current and future state business capabilities, process development, process flows, training, and internal/external communications.
  3. Performs HEDIS process verification/validation audits and presents findings and actionable recommendations.
  4. Collaborate with internal and external vendor and client partners to ensure all HEDIS audit and data capture meets technical specifications and maximizes performance metrics.
  5. Designs performance feedback systems to assess the resolution of business process deficiencies and installs appropriate controls.
  6. Accountable for supporting business teams to identify and deliver significant and quantifiable business improvements through the application of project management and process improvement methodologies.
  7. Provides expertise in analytical methodology, including data analysis, used to facilitate data driven decision making, including the collection and monitoring of HEDIS metrics..
  8. Benchmarks industry best practices to measure organization position.
  9. Consults, develops, and ensures compliance with regulatory standards and specifications.
  10. Initiates and leads problem solving efforts working closely with internal and external stakeholders.
  11. Leads in the research, analysis, identification, and evaluation of data from assigned problems to evaluate existing and potential trends and issues.
  12. Possesses and maintains an extensive comprehensive knowledge of Advantasure business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.
  13. Manages and monitors multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.
  14. Develops lines of communication to discuss/review results of analysis to management via reports/presentations and assists management in implementing programs that provide solutions.
  15. Investigates, reviews, recommends, communicates, and implements solutions which identify problems/root cause of issues.
  16. Identifies and resolves challenges in order to fulfill key corporate objectives and responds to the demands of change management and initiates actions needed to plan, organize, and control team activities.
  17. Independently develops and plans reports, papers, and/or other materials in a clear and concise manner.
  18. Provides expertise and guidance to unit and corporate staff as required.
  19. Acts as a liaison between corporate business areas and participates in group or committee discussions.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

Job Requirements



Bachelor's degree in Business Administration, Economics, Health Care, Information Systems, Statistics, or a related field. Master's degree in a related field is preferred. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.


Seven years experience in a related field, typically in two subject areas (e.g.Healthcare Quality, HEDIS, process improvement, project planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management).


  1. Excellent analytical, planning, problem solving, verbal, and written skills to communicate complex ideas.
  2. Ability to work independently, within a team environment, and communicate effectively with employees at all levels.
  3. Excellent organizational skills and ability to effectively multi task in a dynamic and fast paced environment.
  4. Ability to lead and facilitate cross functional team meetings.
  5. Knowledge of HEDIS technical specifications, medical record review, and audit processes.
  6. Excellent knowledge and use of existing software packages (Visio, Project, PowerPoint, Excel, Word).
  7. Knowledge of HEDIS and Medicare Stars programs,
  8. Ability to understand and apply statistical inference.
Work is performed in an office setting with no unusual hazards.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.


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