Data Quality Analyst

Description

*** THIS IS A REMOTE ROLE BUT THE CANDIDATE MUST RESIDE IN CA! Feedback from the hiring manager;
Partnership provides insurance services to low income customers in California through Medi-Caid funds. In order for the medical providers to continue to be eligible to work with Partnership and provide services tp Partnerships customers, they have to prove that they are providing sound preventative care services to Partnerships customers through a compliance program called HEDIS. Examples of the kind of Provider data that would be reviewed include:

• Did everyone over 70 years of age receive the flu vaccine?
• Did pregnant mothers receive pre-natal care?
• Were patients over 50 screened for colon cancer?

This role has two primary functions:
1. Data Loading & Fulfilling Data Requests a. The team will get the HEDIS provider data from the Landing Zone (after it has been tansformed for use by the Data Warehouse team) and use their SQl skills to load it into the HEDIS Vendor Software Platform called Inovalon. b. The team will also fulfill data requests for anyone at Partnership who requests specific HEDIS data.

They will need their SQL skills to pull the data from a data lake in Inovalon and forward it in an Excel spreadsheet to the team member requesting the data.
2. Data Quality Review for Abnormalities a. Review the provider data look for abnormalities such as in 2024 provider X only screened 30% of patients over 50 for colon cancer and for 2025 they screened them at 80%. They are able to review the detailed data for each metric to determine if it makes sense or not. If not, the abnormalities will need to flagged b.

The QI Analyst will meet with an Auditor from the state and talk through the numbers- why certain providers were flagged, others not These abnormalities will need to flagged and reviewed by a doctor next.

To prepare, analyze, report, and manage data used for both plan-wide and regional decision making for evaluating performance in key quality measures and the effective use of health plan resources on a routine and ad hoc basis. Works collaboratively with departments company-wide to identify data needs, develop and maintain data queries and tools, and complete accurate reporting to support performance and process improvements.

Project/program involvement may include PHCs Healthcare Effectiveness Data Information Set (HEDIS) reporting initiative, Partnership Quality Dashboard (PDQ), PHCs provider pay-for-performance programs, and others as assigned.

Develops and maintains working knowledge (technical and user interfaces) of PHC data management and analytics programs and systems. May manage/monitor data integration into data infrastructure and may lead system-level user testing. Utilizes the Enterprise Data Warehouse and other data sources to identify and isolate data for analysis. Validates data reports and manages key data sources within program requirements, to ensure the completeness and accuracy of data.

Works collaboratively with various departments (i.e. QI, IT, Finance, and Analytics teams) and external stakeholders to define business requirements and identify data needs. Refines reporting requests to support operational excellence initiatives and creates tools and reports to measure process/performance changes. Develops and executes data collection plans that identify baseline performance and capture the impact of interventions. Analyzes performance data (which may include data trending or stratification) to identify areas for improvement.

Provides actionable recommendations and informs stakeholders of the…