Provides expertise in data extraction & data delivery specific to HEDIS, NCQA, Quality improvement & other regulatory requirements. Works w/ the Quality, Risk and Patient Safety team (QRPS) to produce quarterly & annual reports based on regulatory specifications. Maintain & support a culture of compliance, ethics & integrity. Responsible for ensuring ongoing compliance within QRPS. Maintains & supports a culture of compliance, ethics & integrity. Maintains knowledge of policies & procedures & performs in accordance w/ the Principles of Responsibilities & applicable regulatory requirements, external laws & accreditation standards. Appropriately reports observed fraud or abuse.
Essential Functions:
- Provides expertise to the QRPS team in accessing data from interdepartmental systems as required by regulatory agency specifications
- Creates & interprets ad hoc, quarterly & annual reports for regulatory requirements including NCQA, HEDIS, CMI, & CMS
- Problem solves, consults on & resolves data quality issues
- Creates, tests, & maintains programming code to extract data & create reports based on complex HEDIS-specific requirements, as well as other regulatory requirements
- Develops quality control procedures to ensure the accuracy of data & reports
- Maintains a programming code library for regulatory-specific program code & maintains security
- Establishes programming procedures for regulatory requirements such as NCQA & HEDIS
- Provides support & expertise in the consolidation & automation of regulatory data
- Tracks & documents changes to regulatory data & programming coding
- Supervises temporary programmers, contracted for regulatory reporting
- In addition to defined technical requirements, accountable for consistently demonstrating service behaviors & principles defined by the KP Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives
- Also accountable for consistently demonstrating the knowledge, skills, abilities, & behaviors necessary to provide superior & culturally sensitive service to each other, to our members, & to purchasers, contracted providers & vendors
Qualifications:
Basic Qualifications:
- High level of SAS programming skills (5+ years experience)
- Bachelor's degree in business, statistics, IT, or related area
- Equivalent experience will be considered
- Extensive knowledge of IBM mainframe MVS, JCL, & TSO, as well as SQL & PC/SAS
- Extensive knowledge of MS Excel & MS Word
- Strong analytical skills & strong skills in report programming/automation
- Excellent customer service skills, & strong verbal & written communication skills a must
Preferred Qualifications:
- Experience using other analytical and data access tools such as Focus, and EasyTrieve helpful
- Experience with Data Warehouses and Business Objects helpful
- Knowledge of DB2/Oracle & MS Access database management systems helpful
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.