Manager HEDIS, Stars, & ACO Data Analytics #0714

Overview

The Manager of HEDIS, Stars & ACO Data Analytics leads all aspects of HEDIS, Medicare Stars, and ACO quality measurement and reporting across product lines. This role ensures technical excellence, regulatory compliance, audit readiness, and timely submissions in accordance with the National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), and the Executive Office of Health and Human Services (EOHHS).

Duties & Responsibilities

• HEDIS, Stars & ACO Oversight
  • Establish and execute comprehensive operational work plans for HEDIS, Medicare Stars, and ACO quality performance.
  • Lead the full HEDIS lifecycle: planning, data collection, validation, rate calculation, submission, and audit.
  • Ensure compliance with NCQA, CMS, Medicaid, MMP (DSNP), and ACO requirements.
  • Conduct performance analysis and root cause reviews to improve quality scores and financial incentives.
  • Present results and performance insights to leadership and quality committees.
• Data Strategy & Integration
  • Lead initiatives to expand and optimize electronic clinical data exchange with provider EHRs, laboratory systems, and the State immunization registry.
  • Improve data integrity, reporting accuracy, and operational efficiency.
  • Identify and resolve data integrity issues in partnership with data governance and analytics teams.
  • Partner with internal teams and external stakeholders to enhance data systems and quality outcomes.
• Vendor & Audit Management
  • Manage HEDIS software vendors and work with NCQA-certified auditors(s).
  • Lead RFPs, contract oversight, and audit coordination.
  • Monitor specification updates and ensure submission compliance.
• Team Leadership
  • Lead, mentor, and develop cross-functional analytic and clinical staff.
  • Ensure training, cross-training, and timely completion of all deliverables.
  • Manage performance, accountability, and cross-functional team development.
• Collaboration & Strategy
  • Partner with Operations, Clinical, Network, Finance, Analytics, Practice Transformation, Care Management, Pharmacy, and Social Care.
  • Support state and federal reporting requirements.
  • Contribute to budgeting and strategic planning for quality analytics.
• Compliance
  • Adhere to corporate compliance standards and regulatory requirements.

Qualifications

• Education: Bachelor’s degree in health, informatics, data science, or related field required; Master’s degree (MBA, MPH, MS, or related) preferred.
• Experience: 5+ years in healthcare analytics; 5–10 years of HEDIS leadership experience.
• Skills: Experience leading HEDIS audits; Strong knowledge of HEDIS/QRS specifications, Medicare Stars measures, and healthcare data systems; Proven team leadership and project management experience; Strong analytical and communication skills; Vendor management and process implementation experience.