Business Analyst, HEDIS HealthCare

The Business Analyst role at SDS involves managing supplemental data sources such as audit documentation, HEDIS technical specification review, and tracking of data sources. Collaborating with various business areas is essential to ensure efficient data management that meets the highest quality standards and benefits the enterprise across Commercial, Medicare & Medicaid lines of business. The position also focuses on process improvement by identifying data source enhancement opportunities and creating action plans for implementation. Key Responsibilities: Source Management - Understanding clinical supplemental data sources used in HEDIS data processing, including their purpose, intent, and data collection methods. - Ensuring completion and quality of audit documentation. - Handling medical record requests for medical record review or primary source verification related to HEDIS audit. - Familiarity with NCQA HEDIS technical specifications concerning supplemental data and relevant measures. - Tracking source documentation readiness. Data Management - Documenting end-to-end data flow of sources. - Understanding data validation reports of sources. - Knowledge of data load specifications to HEDIS rules engines. Audit Management - Documenting audit review outcomes by source. - Supporting Quality Solutions Delivery with HEDIS audit for all audit groups involved in the annual audit. - Addressing audit issues and concerns within the required turnaround time. - Timely completion of work, especially related to HEDIS audit deadlines. Other Responsibilities: - Developing and producing ad-hoc reports. - Participating in complex analyses and reports. - Working independently and seeking guidance only for the most complex tasks.,