HEDIS Data Analyst

HEDIS Data Analyst

Employment Type: Contract / Contract-to-Hire / Full-TimePractice: Healthcare Data & AnalyticsIndustry: Healthcare / Health Plans / Managed CareExperience: 4+ years of healthcare analytics experience with 2+ years of hands-on HEDIS experience

Position Summary

We are seeking an experienced HEDIS Data Analyst to support HEDIS measurement, quality reporting, data validation, and healthcare analytics initiatives. The ideal candidate will have strong experience working with healthcare claims, clinical, enrollment, pharmacy, and provider data and a solid understanding of HEDIS measures and NCQA requirements.

The HEDIS Analyst will work closely with Quality, Clinical, Data Engineering, IT, Compliance, and business teams to analyze HEDIS performance, identify gaps in care, validate measure results, investigate data-quality issues, and support accurate and timely regulatory and quality reporting.

Key ResponsibilitiesPerform analysis of HEDIS measures using claims, encounter, membership, pharmacy, provider, laboratory, and clinical data.Support HEDIS measurement, reporting, validation, and annual submission activities.Interpret HEDIS technical specifications and translate measure requirements into data and reporting logic.Develop and execute complex SQL queries to extract, analyze, reconcile, and validate healthcare data.Analyze measure numerators, denominators, exclusions, exceptions, and eligible populations.Identify gaps in care and opportunities to improve quality-measure performance.Perform root-cause analysis on unexpected HEDIS results, data discrepancies, and measure-performance changes.Validate data across multiple source systems and ensure completeness, accuracy, and consistency.Partner with data engineering and application teams to troubleshoot source-data and ETL issues affecting HEDIS calculations.Support supplemental data collection and integration from clinical and other approved data sources.Perform reconciliation between source systems, HEDIS platforms, data warehouses, and reporting outputs.Develop dashboards, reports, and analytical summaries showing HEDIS performance and trends.Monitor measure performance across populations, providers, markets, products, and lines of business.Support chart-review and medical-record-review processes when required.Assist with HEDIS audits and respond to auditor questions and data-validation requests.Document business rules, data mappings, analytical methodologies, validation results, and issue resolutions.Collaborate with Quality Improvement teams to identify actionable opportunities for improving quality outcomes.Maintain awareness of annual changes to HEDIS specifications and assess their impact on existing reporting and analytical processes.Required QualificationsBachelor's degree in Computer Science, Information Systems, Data Analytics, Healthcare Informatics, Statistics, Public Health, or a related discipline.4+ years of experience in healthcare data analysis, business intelligence, quality analytics, or a related role.2+ years of direct experience supporting HEDIS reporting or analysis.Strong understanding of HEDIS measures, measure specifications, and quality-reporting concepts.Experience working with health-plan or payer data, including:Medical claims and encountersPharmacy claimsMembership and eligibilityProvider dataLaboratory resultsClinical/EHR dataAdvanced SQL skills, including complex joins, aggregations, subqueries, CTEs, and data validation.Strong analytical and problem-solving skills with the ability to investigate complex data-quality and measure-calculation issues.Experience analyzing large healthcare datasets.Understanding of healthcare coding standards such as ICD-10-CM, CPT, HCPCS, NDC, LOINC, and SNOMED CT.Strong written and verbal communication skills.Ability to communicate technical findings to both technical and non-technical stakeholders.Preferred QualificationsExperience working directly with NCQA HEDIS technical specifications.Experience with HEDIS software or quality-measure platforms.Experience supporting HEDIS audits and validation activities.Knowledge of Electronic Clinical Data Systems (ECDS) measures.Experience with clinical data exchange and interoperability standards, including HL7 and FHIR.Experience with Medicare Advantage, Medicaid, Commercial, Marketplace, or other managed-care populations.Experience with CMS Stars, quality improvement, risk adjustment, or related healthcare quality programs.Experience using visualization and reporting platforms such as Power BI or Tableau.Experience with Python, SAS, R, Snowflake, Databricks, Azure, AWS, or similar analytics technologies is a plus.Key Skills

HEDIS | NCQA | Healthcare Analytics | SQL | Claims Data | Clinical Data | Quality Measures | Gap-in-Care Analysis | Data Validation | ECDS | CPT | ICD-10 | HCPCS | NDC | LOINC | SNOMED CT | HL7 | FHIR | Power BI | Tableau

What Success Looks Like

The successful HEDIS Analyst will combine strong healthcare-domain knowledge with hands-on data-analysis capabilities. This individual should be able to move beyond producing reports and determine why a measure is performing the way it is, identify underlying data or care gaps, and translate those findings into actionable recommendations for Quality, Clinical, Operations, and Technology teams.