Senior Business Systems Analyst

About the role

The role involves managing the monthly HEDIS data load process, ensuring the accuracy and completeness of HEDIS data from various sources, and collaborating with cross-functional teams to deliver HEDIS initiatives.

Responsibilities

• Serve as the primary data management lead for the monthly HEDIS production process, owning the end-to-end intake, loading, validation, reconciliation, and certification of HEDIS data.
• Develop and maintain SQL queries, data mappings, and integrations to support HEDIS quality metrics.
• Independently drive HEDIS data initiatives from requirements through implementation, partnering with IT, ETL, data engineering, vendors, and business stakeholders.
• Perform monthly loading, validation, reconciliation, and monitoring of the HEDIS data management pipeline, ensuring timely and accurate ingestion of all required source data and proactive resolution of data quality issues.
• Lead data quality investigations and root cause analysis related to HEDIS rates, member eligibility, measure compliance, claims lag, supplemental data integration, and vendor feed discrepancies.
• Ensure the accuracy, completeness, and reliability of data utilized in quality management and support downstream reporting, audit, analytics, and regulatory submissions.
• Collaborate with cross-functional teams to define HEDIS data requirements and implement process improvements that expand and integrate new data sources, including vendor feeds, EMR data, digital quality measures, and FHIR APIs.
• Analyze HEDIS production data trends, including membership growth/attrition, claims lag, encounter volumes, vendor submissions, and supplemental data performance, providing actionable recommendations to leadership.
• Maintain detailed documentation of data flows, mappings, transformation rules, vendor dependencies, and production processes to support knowledge transfer, governance, and audit readiness.
• Validate annual HEDIS software upgrades, specification updates, vendor enhancements, and data source changes to ensure production readiness and measure integrity.
• Support HEDIS audits by validating source data, responding to auditor requests, documenting data lineage, and ensuring readiness of both traditional and supplemental data sources.

Requirements

• Bachelor's degree or advanced degree (where required)
• 5+ years of experience in related field
• In lieu of degree, 7+ years of experience in related field
• Proven experience as an Analyst, preferably in quality data management, HEDIS reporting, or a related healthcare analytics role
• Proficient in programming languages such as SQL, Python, R, or similar
• Experience with data management systems and tools (e.g., SQL databases, ETL tools, data visualization software)
• Strong familiarity with FHIR standards (US Core, QICore), digital quality measure (dQM) interpretation, and robust data mapping across claims, clinical, and vendor data sources
• Experience performing recurring (monthly) data loads, monitoring production pipelines, and trend analysis across membership and claims data
• Strong analytical skills with attention to detail and ability to identify data anomalies, trends, and root causes
• Familiarity with quality control processes and standards (ISO, Six Sigma, etc.) is a plus

Qualifications

• Bachelor's degree or equivalent experience in a related field
• Advanced degree preferred
• 5+ years of experience in related field
• In lieu of degree, 7+ years of experience in related field
• Proven experience as an Analyst, preferably in quality data management, HEDIS reporting, or a related healthcare analytics role
• Proficient in programming languages such as SQL, Python, R, or similar
• Experience with data management systems and tools (e.g., SQL databases, ETL tools, data visualization software)
• Strong familiarity with FHIR standards (US Core, QICore), digital quality measure (dQM) interpretation, and robust data mapping across claims, clinical, and vendor data sources
• Experience performing recurring (monthly) data loads, monitoring production pipelines, and trend analysis across membership and claims data
• Strong analytical skills with attention to detail and ability to identify data anomalies, trends, and root causes
• Familiarity with quality control processes and standards (ISO, Six Sigma, etc.) is a plus

Skills

• Application Implementation
• Best Practices Development
• Business Process Improvements
• Business Requirements
• Business Requirements Analysis
• Information Technology (IT) Projects
• Information Technology Project Management
• Requirements Gathering
• Requirements Management
• Technical Architecture

Benefits

Medical, dental, and vision coverage along with numerous health and wellness programs

Pay

$89,174.00 - $142,679.00

Schedule

Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.