HEDIS Data Analyst

What You'll Do

• Develop, validate, and analyze HEDIS measures in accordance with NCQA specifications
• Work with healthcare datasets including claims, eligibility, provider, EMR, pharmacy, and laboratory data
• Build and optimize advanced SQL queries, data transformations, and ETL processes
• Support HEDIS reporting, annual submissions, audits, and executive dashboards
• Validate chart review and abstraction data while helping identify and close care gaps
• Partner with Quality, Clinical, Provider Relations, and Compliance teams to investigate data issues and improve reporting accuracy
• Aid in NCQA audit preparation and maintain required documentation and reporting artifacts
• Identify data quality issues and recommend process improvements

Qualifications

• Strong experience working as a HEDIS Data Analyst within a healthcare payer environment
• Advanced SQL skills with the ability to write and optimize complex queries
• Experience working with claims, eligibility, provider, EMR, pharmacy, and lab datasets
• Deep knowledge of NCQA HEDIS specifications and measure validation
• Experience with both administrative and hybrid HEDIS measures
• Familiarity with healthcare coding standards including ICD-10, CPT, HCPCS, LOINC, and NDC
• Understanding of CMS Star Ratings, care gap initiatives, and NCQA audit processes
• Excellent analytical, problem-solving, and communication skills