HEDIS Data Analyst

Job Summary

HEDIS Data Analyst

Responsibilities

• Develop, validate, and maintain HEDIS measure calculations according to NCQA
• 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

Qualifications

• Utilize advanced SQL and work with diverse healthcare payer
• 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.