HEDIS Data Analyst / Business Analyst

Primary Responsibilities

• Support HEDIS measurement, reporting, validation, and annual submission activities.
• Interpret HEDIS measure specifications and translate business requirements into data and reporting solutions.
• Analyze HEDIS performance results and identify opportunities to improve quality scores and close care gaps.
• Partner with quality, population health, provider engagement, and care management teams to support HEDIS initiatives.
• Auxiliary roles include assisting with HEDIS audits, documentation reviews, and quality assurance activities.
• Gather, analyze, document, and validate business requirements from health plan stakeholders.
• Perform root cause analysis on data quality issues impacting HEDIS, CMS reporting, and operational performance.
• Develop source-to-target mappings, business rules, process flows, and functional specifications.
• Analyze large healthcare datasets and present findings, trends, and recommendations to business stakeholders.
• Support UAT testing, reconciliation, defect resolution, and deployment validation activities.
• Analyze claims, encounters, eligibility, provider, pharmacy, and supplemental data used for HEDIS and CMS reporting.
• Validate data completeness, accuracy, reconciliation results, and reporting outputs.
• Support CMS quality initiatives, STAR Ratings programs, and regulatory reporting requirements.
• Collaborate with business and technical teams to improve reporting processes and data governance practices.
• Understand payer operational workflows including claims processing, provider data, membership, enrollment, and quality management programs.
• Work directly with Huron consultants and client stakeholders to solve complex payer data challenges.
• Facilitate requirements sessions, stakeholder interviews, and process reviews.
• Translate technical findings into business recommendations and executive-level communications.
• Support delivery of strategic payer transformation and data modernization initiatives.

Required Qualifications

• Bachelor's degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or related field.
• Additional relevant work experience in lieu of degree may be considered.
• 4–6+ years of healthcare payer, health plan, or managed care experience.
• Strong hands-on HEDIS knowledge and experience supporting HEDIS reporting initiatives.
• Experience working within a Health Plan, Managed Care Organization, Medicare Advantage, Medicaid, or Commercial payer environment.
• Understanding of CMS regulations, CMS STAR Ratings, quality programs, and regulatory reporting requirements.
• Experience analyzing healthcare data including: Claims, Encounters, Membership/Eligibility, Provider Data, Pharmacy Data, Supplemental Clinical Data.
• Strong business analysis skills including requirements gathering, process documentation, and stakeholder management.
• Advanced SQL experience for healthcare data analysis and validation.
• Experience performing data quality reviews, reconciliations, and root cause analysis.
• Strong communication and presentation skills.