Medicaid State Reporting Analyst

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Position Summary

This position will support East Coast hours, starting at 9:00 AM 

Aetna Clinical Enablement (ACE) has an exciting opportunity for an Informatics Manager to join our HEDIS Data Enablement Team. The Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used healthcare quality data sets in the country. HEDIS reporting is a requirement for NCQA Health Plan Accreditation, CMS Medicare Advantage, Medicare Stars, Exchange, Medicaid, and many states. HEDIS measure results are used within the enterprise and externally to drive quality initiatives that improve the health of Aetna's members.

The HEDIS Data Enablement Team is responsible for managing internal reporting for HEDIS, providing HEDIS measure data and research to support initiatives, and HEDIS capital investment projects such as the transformation of HEDIS reporting to digital. In this role you will apply HEDIS measure, data, and technical platform knowledge to perform complex research and analytics in support of internal HEDIS reporting for high profile stakeholders such as Medicaid, Duals and Long-Term Support Services (LTSS). You will apply CVS Heart-at-Work behaviors to work successfully in a team-based environment where team members work together and support each other to achieve greater excellence.

Responsibilities

• Perform research and analysis of HEDIS aggregate and member level data in a relational database environment, including writing queries to identify trends, draw conclusions, make recommendations, and validate results. Subsequently, compile and communicate the information to internal stakeholders.
• Collaborate with HEDIS Vendor to validate measure run configurations and prioritize the runs to meet stakeholder needs.
• Perform validation of measure run results to identify problems prior to releasing to stakeholders.
• Troubleshoot measure run issues to identify root cause and collaborate with HEDIS Vendor to identify next steps for resolution.
• Perform research to identify opportunities to improve measure logic or source data to improve HEDIS rate results.
• Collaborate with HEDIS Vendor to QA measure updates and QA file layout that pertain to HEDIS and Medicaid State Reporting.
• Support stakeholders to generate member detail files, rate templates and understand their business needs.

The most successful candidates will display these traits:

• Expertise writing SQL queries to work with large complex data sets.
• Ability to understand and probe into technical processes and data.
• Experience working with health care data sources (enrollment, claims, lab, etc)
• Be organized and exhibit attention to detail.
• Ability to manage conflicting priorities and multiple projects concurrently.
• Ability to work independently under general direction.
• Accountable for meeting commitments and audit timelines.
• Driven to provide an excellent customer experience for stakeholders.

Required Qualifications

• 5+ years of data analytics experience.
• 3+ years experience with health care data (enrollment, claims, lab) in a data warehouse environment.
• Experience with HEDIS or other quality measurement program.
• 3+ years experience using advanced SQL querying abilities in a large relational database environment including the ability to handle large datasets from multiple data sources.
• 3+ years experience creating reports and pivot tables in Excel.
• Ability to interpret technical specifications.
• Ability to communicate technical concepts to non-technical audiences (written and verbal).
• Adept at probing into granular details of big data and complex technical processes.
• Strong problem solving skills and critical thinking ability.
• Strong collaboration and communication skills within and across teams.

Preferred Qualifications

• Experience with Microsoft SQL.
• Experience in Snowflake and Google Cloud Platform.
• Experience using Inovalon Converged Analytics application

Education

• Bachelor's Degree or equivalent work experience in the health care industry

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.