Cigna Health Data Senior Specialist in Greenwood Village, Colorado
Responsibilities include management, direction and design of projects that include extracting data from multiple sources, analyzing the results, driving improvement through analysis and recommendations, and presentations to illustrate the analysis essential for meeting external accreditation and regulatory requirements. Evaluate the impact of various internal/external quality initiatives on maintaining/improving the clinical care of CIGNA enrollees, as evaluated annually through HEDIS and other process and outcome measures.
Duties & Responsibilities
• Lead time-limited projects and/or components of larger projects and provide technical guidance to quality staff in evaluating system requirements to support new or modified policies/procedures/processes. This includes developing data management solutions for key business processes including:
Leading HEDIS data collection/reporting/analysis for assigned region or assigned project.
Managing, compiling and analyzing results of key clinical initiatives/interventions for identification of improvement opportunities for clients, CACs, commercial markets, and IFP populations.
Performing statistical analysis and providing quantitative and qualitative analysis of results that drives improvement in rates.
Driving action and improvement through the management, analysis and preparation of outcomes into meaningful information using eligibility, claims, pharmacy, lab, and race/ethnicity data.
Partnering with matrix and external partners to facilitate and drive personalization and localization efforts.
• Define and consult on measurement strategies and tools. Develop, produce, gather and improve reports and scorecards for the purpose of ensuring:
Improvement of population health outcomes
Identification of business opportunities and areas for improvement
Meeting state regulatory requirements
• Facilitate the management and direction of lead projects, determine requirements, establish priorities and monitor outcomes and progress. Evaluate project status and implement changes to improve the team’s effectiveness.
• Develop queries, reports and processes, identifying non-compliant populations for clinical outreach for customers, clients, and Accountable Care Organizations; document processes; summarize findings.
• Provide data management and improve cost savings to annual HEDIS reporting process:
Develop, implement and maintain tools and ad hoc reports to track, trend, and forecast HEDIS EOC performance.
Develop, implement and maintain tools for HEDIS hybrid review, partnering with the Clinical Measurement and CIMA Teams to facilitate medical record retrieval, tracking, and analysis.
Improve accuracy of chase reports by correcting/populating provider addresses, phone numbers, fax numbers, record retrieval zone assignments, etc.
Analyze market-specific HEDIS measures compared to NCQA national/regional results, CIGNA national/regional results and local competitor results.
Identify and develop methods for improvement in processes.
Interface with external partners, managing the HEDIS sample data file submission to state immunization registries.
• Conduct literature search and outreach to clinical team to complete/present HEDIS barrier and competitor analyses and make recommendations to applicable Quality Committees and audiences.
• Identify and document data repository/retrieval methodologies and analysis techniques; train other data analysts to facilitate cross-coverage.
• Assures quality and integrity of data collected, analysis performed, and reports generated. Develops methods for improving internal techniques and processes.
• Maintain Quality SharePoint site.
• Bachelor's Degree highly desired with 5-7 years of related managed care experience strongly preferred.
• Prior experience with HEDIS a plus.
• Demonstrated results and experience in working with big data; working with multiple data schemas/environments.
• Knowledge of data processing software (Access, Excel) required.
• SAS and/or SAS Enterprise Guide (SAS EG) or other equivalent querying tool experience is a plus.
• Understand detailed technical processes and project specifications to support ongoing improvement of Cigna’s initiatives and programs.
• Demonstrated passion for and dedication to anticipating and meeting the expectations and requirements of customers.
• Demonstrated excellent communication and interpersonal skills and ability to effectively organize/present information to various audiences, including upper management.
• Ability to determine opportunities and identify solutions to increase analytical processing efficiency and reduction in costs.
Primary Location: Greenwood Village-Colorado
Work Locations: 8505 East Orchard Road Greenwood Village 80111
Job: Underwriting Support
Employee Status: Individual Contributor
Job Type: Full-time
Job Level: Day Job
Travel: Yes, 25 % of the Time
Job Posting: Aug 22, 2018, 2:04:48 PM
Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: SeeYourself@cigna.com