Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is hiring a HEDIS Analyst to manage, analyze, and interpret healthcare data for HEDIS reporting and quality improvement. The role leads HEDIS validation and submissions, develops reporting and analytics, and works with cross-functional teams to improve data accuracy and healthcare performance.
Responsibilities
- Lead HEDIS lifecycle validation and submission process
- Develop, maintain, and automate HEDIS measure reporting using SQL, Python, Data Bricks, or other analytical tools
- Analyze medical, pharmacy, and enrollment data as needed to validate HEDIS results
- Collaborate with internal and external customers to ensure data accuracy and completeness
- Support supplemental data integration and hybrid review process
- Perform root cause analysis on data quality issues and recommend process improvements
- Design dashboards and reports to track and trend HEDIS performance using Tableau and/or Power BI
- Provide analytical support for interventions aimed at improving HEDIS and STAR ratings performance
- Create visualizations and presentations to communicate findings to leadership and stakeholders
- Mentor analysts and provide technical and analytic guidance
- Lead and contribute data-driven projects that enhance quality reporting capabilities
- Stay current on NCQA specifications, CMS guidance, and healthcare analytics best practices
Skills
- 5+ years of experience in healthcare data analytics, with at least 2 years focused on HEDIS or quality measurement reporting is required
- Proficiency in SQL and or more analytics tools (Data Bricks, Python) is required
- Strong understanding of healthcare data structures (claims, eligibility, etc.)
- Excellent problem solving, analytical, and critical thinking skills
- Strong communication and presentation abilities-able to translate complex data into actionable insights
- High attention to detail and ability to manage multiple priorities in a fast-paced environment
- Bachelor's degree in data science, data analytics, or technology related field is preferred
- Experience with NCQA-certified HEDIS software is preferred
- Experience with HEDIS data submissions is preferred
- Familiarity with CMS STARs, CAHPS, HealthPlan Accreditation is preferred
Benefits
- Remote work options and hybrid work schedules
- Paid time off, including holidays and volunteer events
- Health insurance coverage for you and your dependents starting on Day 1
- 401(k)
- Tuition reimbursement
- Fully remote associates residing in states where service is required by contract, law, or regulation may submit for reimbursement.
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