Job Description
Job Summary HEDIS Data Analyst
- Develop, validate, and maintain HEDIS measure calculations according to NCQA specifications.
- Extract, transform, and analyze healthcare data from claims, eligibility, EHR, pharmacy, and lab sources.
- Support annual HEDIS submissions, including data validation, audit documentation, and quality checks.
- Conduct trend analysis, gap analysis, and monitor HEDIS measure performance.
- Create and deliver weekly/monthly dashboards and reports for stakeholders.
- Design and optimize SQL queries, ETL pipelines, and data transformation processes.
- Collaborate with IT and data engineering teams to resolve data quality issues and document data lineage.
- Manage provider retrieve lists and validate chart abstraction for hybrid HEDIS measures.
- Support provider outreach initiatives to address missing documentation and care gaps.
- Work cross-functionally with Quality Improvement, Clinical, Provider Relations, and Compliance teams.
- Present analytical insights and trends to leadership and answer technical HEDIS queries.
- Assist in HEDIS compliance audit preparation and ensure adherence to NCQA and regulatory requirements.
- Maintain audit trails and detailed reporting documentation.
- Utilize advanced SQL and work with diverse healthcare payer datasets.
- Apply knowledge of healthcare coding standards (ICD-10, CPT, HCPCS, LOINC, NDC).
- Demonstrate expertise in NCQA HEDIS specifications, hybrid/administrative measures, and audit processes.
- Understand care gap workflows and quality improvement strategies within healthcare.
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