Senior Quality Business Intelligence Engineer

6 days ago

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Peak Health

WebsiteLinkedInAll Job Openings

Health Insurance • Managed Care • TPA Services • Pharmacy Benefit Management • Third Party Administrator

51 - 200 employees

⚕️ Healthcare Insurance

🤝 Non-profit

Description

• Help design and build a health plan as a Senior Quality Business Intelligence Engineer. • Develop reports and perform data analysis for Quality, HEDIS, and Stars data. • Collaborate with cross-functional teams to optimize processes for revenue and compliance. • Ensure accuracy of data and assist in strategic decision-making based on analytics. • Support Stars Program strategy and maintain compliance with regulatory obligations.

Requirements

• Bachelor’s Degree in Healthcare Administration, Business Administration, Finance, Economics, Information Systems, or a closely related field • Five (5) years of experience in Quality, Stars, Regulatory Reporting or related field within the healthcare industry. • Three (3) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities and quality outcomes. • Strong knowledge of Quality methodologies and reporting/regulatory requirements (e.g., CMS-HCC). • Strong knowledge of CMS Stars Ratings measures including HEDIS, CAHPS, PQA/Pharmacy, HOS, and CMS Display measures. • Proficiency in data integration tools and techniques. Strong knowledge of database management systems (e.g., SQL, NoSQL), data modeling, ETL processes, and data warehousing concepts. Experience with data visualization and analytics tools (e.g., SAS Enterprise Guide, SAS Visual Analytics, Tableau, Power BI) is preferred. • Demonstrated ability to analyze complex data sets, identify patterns, and derive actionable insights. Familiarity with statistical analysis and machine learning techniques is a plus. • Exceptional problem-solving and critical-thinking abilities, with a keen attention to detail. Ability to identify and resolve technical issues in a timely manner. • Flexibility to adapt to changing priorities and business needs. Ability to thrive in a fast-paced and dynamic environment. • Strong interpersonal and communication skills, both written and verbal, to effectively collaborate with cross-functional stakeholders.