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Business Systems Analyst
Eden Prairie, Minnesota  |  Remote, Onsite
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Applied on May 23, 2022
Job Id #56177 Posted May 4, 2022


Description:

Measures Analyst – RQNS Technical Strategy
  • Manage multiple priorities
  • Have experience and expertise in SQL or other query languages.
  • Be able to read and write technical business requirements documentation with knowledge of content to effectively communicate requirements to technical teams and stakeholders.
  • Ability to understand instructions and requirements and deliver quality work.
  • Self-motivated and ability to troubleshoot and follow up with resources to clarify and correct documentation and workflows.
  • Understand clinical and primary claims repository health plan data and how it is typically processed through certified software vendors working with NCQA or CMS.
  • Demonstrates ability to consistently follow and build requirements for rules engine through analysis of standard requirements from NCQA, CMS, or the state quality performance measurement programs.
  • Understand basic concepts of CMS Risk and Quality Rating System
  • Experience working in a matrix environment
  • Good understanding of an SDLC process and ability to provide recommendations on best practices for development, testing, and deployment.
  • Conduct business, functional, technical, and data analysis to define product requirements for all aspects of healthcare applications including data schema definition, data verification, data quality, data load, analytics rule interpretation and implementation, UAT and testing
  • Understanding of measure analytics to perform investigative research
  • Familiarity with ICD-9-CM, ICD-10-CM, CPT, DRG, LOINC, HCPCS, POS, NDC coding.
  • Be able to understand impacts of input data intake process from various formats and data warehouses
  • Knowledge of claims and claims processing.
  • Provide strategic support in preparation of the Risk and Quality Measures Engine Roadmap and overarching yearly refresh Program.
  • Provide story and agile support for cloud migration and exposure of analytic results via API calls.
  • Be able to work with ambiguity
  • Be able to manage and prioritize large projects with great visibility
  • Candidates can be trained in these criteria and should not be excluded just because of their lack of knowledge in these.

Team Player Qualities:

  • Ability to deal with ambiguity and multiple competing priorities
  • Ability to understand and disseminate information to the team.
  • Ability to work with diverse audiences and speak to the department priorities and goals including upper management.

Qualifications

Education:

  • A Bachelor's Degree or equivalent years of experience.

Experience:

  • 1+ years of CMS risk adjustment model/version experience or ACA or Medicaid model risk adjustment. HEDIS, STARS, State quality performance measurement experience performing a wide range of functions with strong focus on measures development.
  • 2+ years of data analysis experience
  • 2+ years working with certification to NCQA, CMS, and/or other state measure requirements
  • 2+ years of writing SQL and/or PL/SQL
  • Intermediate knowledge of Excel
  • Knowledge of Medicare, Medicaid and/or ACA programs
  • Knowledgeable of current trends in HEDIS and CMS Quality Rating System in managed health care
  • 1+ years of experience working in a matrix environment

Special Skills:

  • Knowledgeable of current trends in HEDIS in managed health care.
  • Knowledge of NCQA, CMS, HOS, and CAHPS requirements
  • Familiarity with ICD-9-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding

Horizontal is proud to be an Equal Opportunity and Affirmative Action Employer. We seek to provide employment opportunities to talented, qualified candidates regardless of race, color, sex/gender including gender identity and/or expression, national origin, religion, sexual orientation, disability, marital status, citizen status, veteran status, or any other protected classification under federal, state or local law.

In addition, Horizontal will provide reasonable accommodations for qualified individuals with disabilities. If you need to request a reasonable accommodation in order to complete the application or interview process, please contact hr@horizontal.com.

All applicants applying must be legally authorized to work in the country of employment.

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You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.

Horizontal is proud to be an Equal Employment Opportunity/Affirmative Action Employer providing a drug-free workplace.

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