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HEDIS MRR Data Subject Matter Expert - Telecommute

UnitedHealth Group

Eden Prairie, MN
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Job Details

734073 HEDIS MRR Data Subject Matter Expert Telecommute

HEDIS MRR Data Subject Matter Expert - Telecommute (734073)

Position Description

Primary Responsibilities:

  • Manage multiple priorities

  • Have experience and expertise in SQL

  • Be able to read, and write SQL code with knowledge of inner and outer joins, table and view properties, and ability to review and understand a data dictionary as it relates to a database environment

  • Understand HEDIS MRR data requirements from point of abstraction, data result coding, MRR data integration, scoring of measure results against administrative data and NCQA guidelines on medical record data use for reporting, and final data results on IDSS.xml files and PLD

  • Have expertise in health plan sampling and chase data; how sampling process works with random seed, provider data and chase logic election and how it impacts retrieval and abstraction works, etc

  • Understand Supplemental data concepts for HEDIS and how it impacts MRR process and rules for converting MRR data into future administrative data source for data runs

  • Experience working in a matrix environment

  • Develop data driven metrics to identify gaps and implement interventions to improve results on key hybrid performance measures

  • Thorough understanding of measure analytics to perform investigative research

  • Evaluates and prioritizes recommendations for quality improvement to customers

  • Familiarity with ICD-9-CM, ICD-10-CM , CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding

  • Be able to translate data from various formats and data warehouses

  • Be able to merge and append data from various sources

  • Experience in Data Validation

  • Provide guidance to clients on MRR data issues and MRR data questions and set up data tollgates / controls

  • Knowledge of claims and claims processing and how this impacts MRR data collection with administrative refreshes

  • Demonstrates ability to consistently follow published HEDIS and Stars technical specifications

  • Provide strategic support in preparation of the HEDIS Roadmap, HOQ, HEDIS audit, and Primary Source Verification

  • Be able to work with ambiguity

  • Be able to manage and prioritize large projects with great visibility

  • Be able to present to clients’ data results via WebEx and onsite auditor presentations

  • Intermediate to expert level in MS Office, especially MS Excel for data validation reports and summary rate report compilation of results / edits required, PowerPoint presentations, creating dashboard reporting, etc

Required Qualifications:

  • Bachelor's degree or equivalent years of experience

  • 3+ years of experience in Medical Record Review (MRR) projects at a vendor level and/or health plan organization level

  • 3+ years of experience in a health care delivery organization, such as a managed care organization

  • 3+ years of HEDIS experience, performing a wide range of functions with strong focus on data analysis and reporting

  • 5+ years of data analysis experience

  • 3+ years of working with final submission files to NCQA, CMS, California P4P, NY QARR, and/or other state submissions

  • 3+ years of writing SQL code

  • Intermediate knowledge of Excel

  • Knowledge of Medicaid and/or Medicare programs

  • Knowledge of CMS Star Rating programs impacted by MRR data

  • Knowledgeable of current trends in HEDIS in managed health care

  • Understand basic concepts of CMS Quality Rating System

  • 1+ years of experience working in a matrix environment


Special Skills:

  • Knowledgeable of current trends in HEDIS in managed health care

  • STARS experience

  • Knowledge of NCQA MRR, CMS, HOS, and CAHPS requirements

  • Familiarity with ICD-9-CM / ICD-10-CM, CPT, DRG, LOINC, HCPCS, TOB, POS, NDC coding


Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.


Job Keywords: HEDIS, STARS, MRR, Medical Record Review, SQL, MEDICARE STARS, data analysis, telecommute, telecommuter, telecommuting, remote, travel, work from home

Job Details

  • Contest Number734073
  • Job TitleHEDIS MRR Data Subject Matter Expert - Telecommute
  • Job FamilyBusiness Operations
  • Business SegmentOptumInsight

Job Location Information

  • Eden Prairie, MN
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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