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Humana’s Health Quality and Stars organization is seeking a Senior Data Quality/Integrity Engineer to deliver quality and value in a fast-paced, dynamic environment. The successful candidate will be self-directed, highly-engaged, and will demonstrate expertise and business intelligence in supporting execution of the HEDIS program and related activities, all within tightly regulated requirements and timelines. This will require building and maintaining strong relationships with corporate and market teams, including IT, Quality Operations and Compliance, and Risk Adjustment, as well as vended partners.

The Senior HEDIS Operations & Quality Professional supports all aspects of the non-standard supplemental (NSS) program; including: systems readiness, process improvements, resource deployment, technology implementation, and data management/reporting. The Senior HEDIS Operations & Quality Professional champions a collaborative environment where the team and connected partners align on appropriate strategies for each successful season, ensuring all regulatory submissions of data collection and reporting are accurate, complete and timely. The ideal candidate for this role will thrive in a fast-paced and complex working environment, demonstrate a high level of business and operational acumen, have experience in executing high-priority projects with full accountability, monitor and respond to performance, and cultivate and mature partnerships within the enterprise. Through individual and team contributions, Senior HEDIS Operations & Quality Professional is responsible for the following:

• Become an expert in HEDIS & Stars specifications, processes, and schedules
• Interpretation of the NCQA technical specifications and regulatory audit requirements to partner on data/process updates; and to provide insights, impacts and guidance to the enterprise
• Establish and maintain effective professional relationships with key upstream and downstream partners
• Development and maintenance of operational workflows, processes, use of technology and systems
• Support clinical quality improvement by championing continuous improvements to operational processes and  systems/tools development
• Partner to drive and oversee comprehensive program to support quality improvements and holistic data capture
• Manage multiple data sets from varying systems to inform resource needs, data value, and report metrics
• Interpretation and presentation of complicated and large data sets to identify trends, data scenarios, and opportunities for improved member health and measure compliance
• Internal and external partnerships to coordinate, guide, direct and oversee day-to-day HEDIS activities, including: contingency planning and mitigation, communications, metrics, reporting and prioritization
• Development, tracking and presentation of metrics to ensure data quality, timeliness, and accuracy
• Identify opportunities across HEDIS processes to ensure compliance and audit requirements are satisfied, while also simultaneously maximizing gap closure

Professional Maturity

• Passion for contributing to a cross-functional team focused on continuously improving member experiences and clinical outcomes though data analysis and interpretation

• Establish and maintain effective professional relationships with key upstream and downstream partners

Operational Execution

• Ensure data quality, timeliness and accuracy

• Leverage existing talent and expertise within department to drive efficiency and effectiveness

• Champion improvements to existing processes

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree or equivalent experience
• Background in operations and/or project management with strong organizational and critical thinking skills
• Demonstrated ability to articulate ideas effectively (written and verbal) to effectively communicate across teams, levels and functions
• Be agile and adaptable to shifting priorities
• Passionate about contributing to an organization focused on continuous improvement and driving results
• Able to learn and leverage multiple systems and data sets
• Self-starter who assumes accountability for their team’s success and strives to maximize results for the enterprise
• Comfortable working in fast-paced environment with an ability to manage multiple simultaneous time-sensitive deliverables
• Demonstrated excellence in problem solving/critical thinking with exceptional attention to detail
• Proficiency in Microsoft Office applications, including Word,