HEIDIS Consultant on W2

HEIDIS Consultant Job Summary:

The HEDIS Consultant is responsible for designing, building, and optimizing healthcare data pipelines and analytical solutions to support HEDIS reporting and quality measurement initiatives. The role involves integrating data from multiple sources (including Facets), developing scalable workflows in Azure Databricks, and ensuring compliance with NCQA and CMS quality standards.

This position requires a blend of technical expertise in data engineering and healthcare domain knowledge to deliver accurate, timely, and actionable insights for quality performance improvement.

Key Responsibilities

• Develop, automate, and optimize HEDIS data pipelines using Azure Databricks, Azure Data Factory, and Synapse Analytics.
• Ingest, transform, and validate healthcare data from Facets (claims, eligibility, provider, and encounter data).
• Translate HEDIS specifications and NCQA technical requirements into SQL or PySpark-based logic for measure calculation.
• Collaborate with data analysts, clinical teams, and business stakeholders to deliver accurate HEDIS performance reports.
• Implement robust data quality checks and auditing processes across data ingestion, transformation, and reporting layers.
• Manage and monitor ETL/ELT workflows, ensuring scalability, reliability, and performance optimization.
• Participate in annual HEDIS submission cycles supporting data extraction, validation, and NCQA compliance.
• Develop dashboards and visualizations in Power BI or Azure Synapse to track measure performance.
• Collaborate with IT and architecture teams to enforce security, governance, and privacy controls across Azure environments.
• Support ad-hoc analysis, root-cause investigations, and quality improvement initiatives tied to HEDIS measures and STAR ratings.

Required Qualifications

• Bachelor s degree in Computer Science, Information Systems, Data Analytics, or a related field.
• 4+ years of experience working with HEDIS or healthcare quality measurement data.
• Strong expertise with:
  • Azure Databricks (PySpark, Delta Lake, notebooks)
  • Azure Data Factory, Data Lake, Synapse Analytics
  • SQL and data modeling for large-scale healthcare datasets
  • Facets core claims and enrollment data structures
• Solid understanding of NCQA HEDIS measures, healthcare claims processing, and quality reporting logic.
• Experience developing and optimizing ETL pipelines and data validation frameworks.
• Strong analytical, problem-solving, and communication skills.

Preferred Qualifications

• Experience with HEDIS vendor platforms (e.g., Cotiviti, Inovalon, MedInsight).
• Familiarity with FHIR, HL7, and EDI (837/835/834) data formats.
• Knowledge of Azure DevOps, Git, CI/CD pipelines, and Infrastructure as Code (IaC).
• Exposure to Power BI, Tableau, or Synapse dashboards for healthcare metrics visualization.

Key Competencies

• Deep understanding of healthcare quality data and reporting workflows.
• Strong technical problem-solving skills and attention to data accuracy.
• Ability to work collaboratively in cross-functional healthcare analytics teams.
• Excellent documentation and communication abilities.
• Commitment to compliance, data governance, and regulatory standards.