HEDIS Data Analyst, Business Analyst

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Assist in HEDIS measurement, reporting, validation, and annual submission processes.

• Interpret HEDIS measure specifications and convert business requirements into data and reporting solutions.

• Examine HEDIS performance results to identify opportunities for enhancing quality scores and closing care gaps.

• Collaborate with quality, population health, provider engagement, and care management teams on HEDIS projects.

• Aid in HEDIS audits, documentation assessments, and quality assurance activities.

• Collect, analyze, document, and validate business requirements from health plan stakeholders.

• Conduct root cause analysis on data quality issues impacting HEDIS, CMS reporting, and operational performance.

• Create source-to-target mappings, business rules, process flows, and functional specifications.

• Analyze extensive healthcare datasets and present findings, trends, and recommendations to business stakeholders.

• Support UAT testing, reconciliation, defect resolution, and deployment validation.

• Evaluate claims, encounters, eligibility, provider, pharmacy, and supplemental data for HEDIS and CMS reporting.

• Ensure data completeness, accuracy, reconciliation results, and reporting outputs.

• Contribute to CMS quality initiatives, STAR Ratings programs, and regulatory reporting requirements.

• Work with business and technical teams to enhance reporting processes and data governance.

• Comprehend payer operational workflows and address complex payer data issues alongside Huron consultants and client stakeholders.

• Lead requirements sessions, stakeholder interviews, and process evaluations.

• Convert technical findings into business recommendations and communications for executive-level audiences.

• Support strategic payer transformation and data modernization efforts.

⛳️ Requirements

• W2 hourly position; not open to H1B or 3rd Party Vendors.

• Bachelor’s degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or a related field; additional relevant work experience may be accepted in place of a degree.

• 4–6+ years of experience in healthcare payer, health plan, or managed care.

• Solid hands-on knowledge of HEDIS and experience in supporting HEDIS reporting initiatives.

• Experience in a Health Plan, Managed Care Organization, Medicare Advantage, Medicaid, or Commercial payer setting.

• Familiarity with CMS regulations, CMS STAR Ratings, quality programs, and regulatory reporting requirements.

• Experience in analyzing claims, encounters, membership/eligibility, provider, pharmacy, and supplemental clinical data.

• Strong business analysis capabilities, including requirements gathering, process documentation, and stakeholder management.

• Advanced SQL skills for healthcare data analysis and validation.

• Experience in conducting data quality reviews, reconciliations, and root cause analysis.

• Excellent communication and presentation abilities.

🏝️ Benefits

• Medical, dental, and vision insurance for employees and their dependents.

• 401(k) plan with an attractive employer match.

• Employee stock purchase program.

• Generous Paid Time Off policy.

• Paid parental leave.

• Adoption assistance.

• Wellness Program that includes free annual health screenings and coaching.

• Bank at work.

• On-site workshops.

• Continuous programs celebrating significant employee life events.