Job Summary HEDIS Data Analyst
- Develop, validate, and maintain HEDIS measure calculations according to NCQA specifications.
- Extract, transform, and analyze healthcare data from claims, eligibility, EHR, pharmacy, and lab sources.
- Support annual HEDIS submissions, including data validation, audit documentation, and quality checks.
- Conduct trend analysis, gap analysis, and monitor HEDIS measure performance.
- Create and deliver weekly/monthly dashboards and reports for stakeholders.
- Design and optimize SQL queries, ETL pipelines, and data transformation processes.
- Collaborate with IT and data engineering teams to resolve data quality issues and document data lineage.
- Manage provider retrieve lists and validate chart abstraction for hybrid HEDIS measures.
- Support provider outreach initiatives to address missing documentation and care gaps.
- Work cross-functionally with Quality Improvement, Clinical, Provider Relations, and Compliance teams.
- Present analytical insights and trends to leadership and answer technical HEDIS queries.
- Assist in HEDIS compliance audit preparation and ensure adherence to NCQA and regulatory requirements.
- Maintain audit trails and detailed reporting documentation.
- Utilize advanced SQL and work with diverse healthcare payer datasets.
- Apply knowledge of healthcare coding standards (ICD-10, CPT, HCPCS, LOINC, NDC).
- Demonstrate expertise in NCQA HEDIS specifications, hybrid/administrative measures, and audit processes.
- Understand care gap workflows and quality improvement strategies within healthcare.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
- Dice Id: 91139002
- Position Id: 2026-16
- Posted 5 days ago
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