Company or Affiliated Company :

AHI agilon health, inc.

Location :

Remote - USA

Job Title :

Quality Data Analyst

Job Description :

The Quality Data Analyst is responsible for pulling the necessary data files from our various health plan partners’ websites, portals, stfp sites. The Quality Data Analyst is also responsible for sending data back to our various health plan partners, in order to ensure gaps are being closed via standard, non-stand data submissions and lab files. The Quality Data Analyst keeps a running tracking log to be able to monitor that the process is up-to-date and/or identify gaps on a weekly basis.

The Quality Data Analyst is the first point of contact for the contracted health plans when there is an interruption or change in the data workflow; issues with the files, new or updated file layouts for data submission, new or updated gap reports layouts, etc. The Quality Data Analyst also acts as a liaison between Quality/EDI/CORE; Creates tickets with CORE and IT as needed for any issues identified within the CORE system and/or regarding the help of IT. Monitors open tickets and requests follow ups/status checks with CORE/IT, as needed, and provide the staff and manager with updates. This is a very important job that is absolutely essential for the company to be able to have pertinent data flow to and from the contracted health plans.

Key Responsibilities

The following duties and responsibilities generally reflect the expectations of this position but are not intended to be exhaustive.

• Responsible for gathering Data files from our contracted Health Plans for all of our Markets (California, Hawaii, Ohio, Texas and new markets)
• Accesses the appropriate SFTP Sites or Portals or receives the files via Secure Email for some
• Gathers the following files:
  • Gap Reports
  • Pharmacy Files
  • Lab Files
• Maintains work through a Tracking Log
• Renames and tracks the files to be able to upload into CORE
  • Works closely with CORE team to set up the naming convention
  • Must Work with CORE if any changes are needs on ANY files; Layouts, naming, Ad Hoc, etc.
• Posts the files to the FTP site to have CORE grab and upload
  • Reaches out to CORE as needed if any errors are found, etc.
  • If there are any Errors or any Fails, the QDA reviews and identifies and works with CORE to resolve
• Acts as a Main Point of Contact for Dept regarding the Systems
  • Liaison between Quality/EDI/CORE
    • Creates/opens tickets with CORE and IT as needed for any issues we cone across within the CORE system and/or regarding the help of IT
      • “Broken” issues
      • NEW issues
      • Creation of new reports as needed
    • Monitors open tickets and requests follow ups/ status checks with CORE/IT as needed
    • Providers the staff and manager with updates
• Enters supplemental data into CORE to close open gaps- HEDIS/STARS
  • Reviews medic records to identify gaps that can be closed via nonstandard supplemental data
• Audits NEW Staff’s entries
  • Provides feedback and corrections as needed until the staff is error free for 3 months
• Audits seasoned staff’s entries- Internal Audit
  • Randomly reviews entries made and the medical records reviewed to assure compliance and meets the HEDIS Specs
  • This is to make sure the dept’s entries will pass a HP audit

Location: Remote

Qualifications:

Education: High School Diploma or equivalent required, some advanced education preferred.

Experience: A minimum of three to five years of IPA / HMO experience in P4P/HCC/CMS Star Programs. Excellent written/verbal communication skills. Advanced ability to manage and work assignments with minimal supervision or absence of detailed instruction. Ability to work independently and in a team environment. Ability to multi-task on the telephone and computer Advanced in Microsoft Excel and proficient in Microsoft applications Must be able to speak, read, and write English proficiently Ability to effectively present information and respond to questions from managers, peers, physicians, members and the general public Knowledge of IPA / HMO Advanced knowledge of P4P programs Advanced knowledge of HEDIS Measures

Knowledge of Roadmap and audit process