[Remote] Lead, Data Quality/Integrity - HEDIS Supplemental Data at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Bachelor's degree
Minimum 8 years experience in data focused role utilizing reporting and analytics applications and tools
Minimum 6 years experience working with healthcare data and/or lab data
Minimum 5 years experience of data analytics and business intelligence platform to include but not limited to SQL, PowerBI, and others
Demonstrated ability to articulate ideas effectively in both written and oral forms
Creative thinking focused on solving problems and identifying simple and innovative solutions
Preferred Qualifications
Knowledge and experience with HCPCS and CPT codes
Experience presenting information to executive leadership
Experience in provider engagement, MRA or STAR
Familiarity with HEDIS measures

Responsibilities

Provide expertise, leadership, and positivity while helping the team identify, consult on, develop, and maintain key supplemental data connections
Engage market and provider offices to establish high value data connections and to educate them on data intake processes and procedures
Communicate data processing status and improvement opportunities to management, markets, and other stakeholders
Provide operational reporting on progress, challenges, and achievements to management
Partner with Medicare Risk Adjustment (MRA) and vendors to establish data feeds for STARs data and maximize the quality of the data procured digitally and manually
Support STARs Clinical Team to gather data for pilots and Humana acquisitions
Submit FTP requests, approve UAT and postproduction, and partner on most aspects of data acquisition development and deployment of data focused enhancements and functionality
Partner with internal HEDIS operations and compliance teams on the maintenance of policies, processes, and procedures in support of the annual HEDIS roadmap
Support annual standard and nonstandard supplemental data audit with NCQA and DTS auditor

Skills

Key technologies and capabilities for this role

Data QualityMaster Data ManagementHealthcare DataClinical DataData ExplorationQuality ControlOperational ReportingProcess ImprovementFTPUATMedicare Risk AdjustmentHEDISSTARsData Connections

Questions & Answers

Common questions about this position

What are the required qualifications for the Lead, Data Quality/Integrity role?

Candidates need a Bachelor's degree, minimum 8 years in a data-focused role with reporting and analytics tools, 6 years with healthcare or lab data, and 5 years with data analytics platforms including SQL and PowerBI.

What is the salary or compensation for this position?

This information is not specified in the job description.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What does the team environment look like at Humana for this role?

This role is part of the Quality Systems Integration (QSI) team, emphasizing collaboration with internal and external teams, leadership, positivity, and a focus on continuous process improvement and operational excellence.

What makes a strong candidate for this Lead, Data Quality/Integrity position?

Strong candidates will have demonstrated ability to articulate ideas effectively, creative thinking for problem-solving, experience with HCPCS and CPT codes, and experience presenting, in addition to meeting the required qualifications.

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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