HEDIS Performance Analytics Lead

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

📋 Description

• Oversee predictive modeling to pinpoint members at risk of care gaps and prioritize outreach initiatives.

• Carry out statistical analyses to determine the factors influencing HEDIS performance variation.

• Create strategies for provider, population, and geographic segmentation.

• Develop forecasting models and simulate various intervention scenarios.

• Convert analytical insights into actionable recommendations for executive and operational stakeholders.

• Identify high-value improvement opportunities by assessing impact, feasibility, and ROI.

• Provide guidance on trends, risks, and opportunities related to HEDIS performance.

• Establish frameworks for measuring the effectiveness of HEDIS interventions.

• Conduct pre/post and longitudinal analyses to assess program impact.

• Measure financial and quality outcomes, including Stars impact, incentive revenue, and cost-of-care considerations.

• Design and manage enterprise-level HEDIS dashboards and reporting tools.

• Collaborate with the Analytics and Reporting HEDIS Technical team to ensure data quality, integration, and accessibility.

• Streamline reporting and insight generation for real-time performance monitoring.

• Work alongside Clinical, Quality, Provider Engagement, and Operations teams.

• Equip stakeholders with data, tools, and insights to drive targeted improvement efforts.

• Present analytical findings and recommendations to senior leadership.

• Maintain comprehensive knowledge of HEDIS specifications, including hybrid and administrative measures.

• Discover opportunities to enhance measure capture, coding accuracy, and documentation processes.

• Aid in audit readiness through data validation and performance reconciliation.

⛳️ Requirements

• 7-10+ years of experience in healthcare analytics, HEDIS, or quality performance improvement.

• Advanced analytical capabilities, including predictive modeling, statistical analysis, and handling large datasets.

• Proficiency in converting data into actionable insights that lead to measurable outcomes.

• Expertise in SQL, Python, or R.

• Experience with Tableau or Power BI.

• Preferred experience with NCQA HEDIS measures and reporting processes.

• Familiarity with Medicare Stars, Medicaid quality programs, and value-based care models is preferred.

• Preferred experience working with claims, EHR, and supplemental data sources.

• A Master’s degree in Data Science, Public Health, Biostatistics, Healthcare Analytics, or a related field is preferred.

🏝️ Benefits

• Medical, Dental & Vision coverage.

• Retirement Plan.

• Paid Time Off.

• Holidays.

• Volunteer time off.

• Incentive Plan.

• Tuition Reimbursement.

• Flexible environment.

• Training and continuing education.

• Opportunities for professional and personal growth.

• Community volunteering opportunities.