Senior Quality Business Intelligence Engineer

6 days ago

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WVU Medicine

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neurosurgery • pediatrics • emergency medicine • cardiothoracic surgery • cancer services

10,000+ employees

⚕️ Healthcare Insurance

Description

• Design and build a health plan as a Senior Quality Business Intelligence Engineer. • Collaborate with cross-functional teams to ensure data accuracy and compliance. • Develop reports and data analysis to drive results for Quality, HEDIS, and Stars ratings. • Support Stars Operations through reporting and strategic roadmap execution. • Ensure compliance with regulatory requirements and prepare reports on performance metrics.

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. • 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.