HEDIS Business Intelligence Lead

📋 Description

• • As a Business Intelligence Lead at Humana Inc., you will be at the forefront of driving significant improvements in our quality performance, specifically focusing on HEDIS and Medicare Stars measures. This pivotal role demands a deep technical understanding of measure logic, coding requirements, documentation standards, and data capture strategies. You will be instrumental in translating complex regulatory and technical guidance into practical, scalable solutions that directly impact our ability to achieve superior quality outcomes for our members.
• • Your primary responsibility will involve the meticulous technical interpretation and operational application of HEDIS and Medicare Stars measure requirements. This includes conducting in-depth research into measure specifications, evaluating the strategic use of supplemental, clinical, interoperability, claims, pharmacy, and provider data, and assessing the performance implications of various data sources and strategies.
• • You will serve as a key partner in identifying and operationalizing opportunities to enhance our quality performance across these critical programs. This involves advising on complex scenarios that influence measure performance and collaborating closely with cross-functional teams to implement changes that have a material impact on our quality ratings and member care.
• • The ideal candidate will possess a robust combination of healthcare quality knowledge, a keen technical curiosity, exceptional data fluency, and a proven ability to collaborate effectively across diverse teams. You must be comfortable navigating ambiguity, dissecting detailed technical requirements, and providing strategic guidance on how coding practices, documentation standards, operational workflows, and data strategies can be optimally aligned to elevate measure performance.
• • A significant aspect of this role involves acting as a technical advisor to leadership and stakeholders. You will provide expert insights on nuanced quality measurement questions, identify emerging requirements, and help evaluate new opportunities to ensure Humana remains a leader in healthcare quality.
• • You will play a crucial role in translating evolving guidance from regulatory bodies like CMS and NCQA into actionable business recommendations. This includes developing repeatable approaches for implementing these changes across the enterprise, ensuring consistency and effectiveness.
• • Identifying and mitigating risks, gaps, and dependencies related to coding, documentation, data sourcing, and workflow design will be a core function. Your proactive approach will help safeguard our quality outcomes and ensure compliance.
• • You will be responsible for strengthening the enterprise's collective understanding of measure intent, data requirements, and performance levers. This will be achieved through clear, concise communication and by demonstrating strong technical leadership, fostering a culture of data-driven quality improvement.
• • This role requires a strategic mindset to evaluate how various data types – including claims, clinical records, pharmacy data, provider information, and supplemental data – can be leveraged to not only support quality measurement but also drive operational execution and improve member health.
• • You will collaborate extensively with business units, clinical teams, interoperability specialists, reporting analysts, and operational departments. This cross-functional partnership is essential to ensure that technical measure guidance is seamlessly integrated with broader enterprise needs and strategic objectives.
• • By providing deep technical expertise, you will help Humana navigate the complexities of healthcare quality measurement, ensuring we meet and exceed industry standards and deliver exceptional value to our members.
• • This position offers a unique opportunity to make a tangible impact on the health and well-being of millions of individuals by optimizing the systems and strategies that underpin our quality performance metrics. Your work will directly contribute to Humana's mission of putting health first.