Lumeris HEDIS Analyst in St. Louis, Missouri
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Role and Responsibility
Complete comprehensive and thorough medical record review to extract medical record data per NCQA specifications for the health plan’s HEDIS project
Conduct investigation to identify potential locations for medical records
Maintain confidentiality of Protected Health Information according to HIPAA guidelines and Lumeris policy
Review data to ensure compliance to External Accountability Set (EAS) performance measures
Review medical records and charts for all HEDIS measures
Performs member outreach calls aimed at linking members to preventive care services and medication adherence
Maintains compliance with all Federal, State and Local laws and regulations in all activities
Assists HEDIS Review Nurses with activities related to HEDIS project execution
Identifies population based member barriers to care and works with the team to identify strategies to overcome barriers and close clinical gaps in care
Complete ad hoc reports as required for development of trend report and metrics to support HEDIS quality programs and initiatives of obtaining the highest possible star rating
Other duties as assigned
Experience, Qualifications and Education
Bachelor’s degree (preferred) or equivalent experience
LPN or other clinical certification strongly preferred
5+ year of experience working in the healthcare industry
Deep Understanding of Health Insurance Portability Accountability Act
Demonstrated experience learning and operating proprietary applications
Excellent written and verbal communication skills are required
2+ experience working on HEDIS projects
Demonstrated proficiency working with business applications like Microsoft Word, Excel and Outlook
Demonstrated experience working with competing priorities and firm deadlines
Ability to work independently as well as with a team
Ability to assist HEDIS Specialists with questions or issues
Ability to keep detailed notes
Lumeris is an EEO/AA employer M/F/V/D.
St. Louis, MO
XL - FT
Join Our Growing Team!
Lumeris serves as a long-term operating partner for organizations that are committed to the transition from volume- to value-based care and delivering extraordinary clinical and financial outcomes. Lumeris enables clients to profitably achieve greater results through proven playbooks based on collaboration, transparent data and innovative engagement methodologies. Lumeris offers comprehensive services for managing all types of populations, including launching new Medicare Advantage Health Plans, Commercial and Government Health Plan Optimization, and Multi-Payer, Multi-Population Health Services Organizations (PHSOs). Currently, Lumeris is engaged with health systems, provider alliances and payers representing tens of millions of lives moving to value-based care.
Over the past seven years, we have tripled in size to more than 800 employees and built the only solution on the market with our proven outcomes. For the past six years, Essence Healthcare, a long-standing Lumeris client, has received 4.5 Stars or higher from the Centers for Medicare and Medicaid Services (CMS). Essence Healthcare was Lumeris’ pioneer client and has been leveraging Lumeris for more than a decade to operate its Medicare Advantage plans, which serve more than 60,000 Medicare beneficiaries in various counties throughout Missouri and southern Illinois.
In 2018, Lumeris was named Best in KLAS for Value-Based Care Managed Services in the area of client-reported impact on the Triple Aim by KLAS Research. This was the third year in a row Lumeris received the award, and it has only been given for three years. As the industry’s most reliable and effective partner for developing population health management solutions, our success is driving tremendous growth in our company. Join us today in making a real difference in how healthcare is delivered!
Why Join Lumeris?
At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.