Senior Payor Transformation Analyst – HEDIS/Quality

Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for a Senior Payor Transformation Analyst – HEDIS/Quality Measure in Anaheim, CA.

This is a hybrid position (3 days in office/2 days remote). 

The Senior Payor Transformation Analyst will report to the Director of Performance Improvement and Project Facilitation and assist in ensuring Melody Health’s successful transition to a value-based care model.

This analyst will lead and manage Healthcare Effectiveness Data and Information Set (HEDIS) and quality performance projects and workflows.

Key tasks for this analyst include identifying opportunities for internal process improvements to enhance/maintain quality scores and coordinating workflows with internal departments.

This individual will bridge multiple departmental and health plan criteria to efficiently meet all benchmark and performance standards.

This position will be a resource to Contracting, Revenue Cycle Management, Operations, Quality, Case Management and Clinical leadership in executing and enhancing Melody Health quality performance metrics.

At PPOSBC, we understand the importance of a well-rounded benefits program and are dedicated to providing you with unique benefits that meet the needs of you and your family.

We are proud to offer a range of plans that help protect you in the case of illness or injury including:


* A competitive benefits package includingl: medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability.


* Benefits coverage starts after one full month of employment!


* Generous vacation, sick, and holiday benefits!


* Generous 401(k) matching contributions and more!


* To view our detailed benefits guide, please visit our career site at www.pposbccareers.org 

Responsibilities

Essential Functions: Essential functions encompass the required tasks, duties and responsibilities performed as part of the job and the reason the job exists.

 

Health Plan/Managed Care


* Attend all relevant Health Plan meetings, trainings, webinar, etc.

regarding plan updates, quality scoring, new contract requirements, quality measures, etc.

Communicate vital information back to departments with any recommendations/concerns


* Liaison and address any health plan, provider or departmental questions with exceptional professionalism and diligence


* Informs and leads discussions with internal departments of contract changes, requirements or recommendations and facilitates the development of operational processes to align Melody Health’s Primary Care Division with payor requirements


* Review, investigate and address payor inquiries and complaints and escalate complex matters to appropriate leaders


* Coordinate JOM, Quality, or other meetings between internal and external stakeholders

 

Quality/HEDIS Measure


* Monitor, review and manage reports of all HEDIS, utilization, P4P and any other quality...