Note: The job is a remote job and is open to candidates in USA. Healthcare IS is seeking a HEDIS Architect / Data Analyst to support healthcare payer quality reporting and data modernization initiatives. The role focuses on HEDIS measurement, CMS quality programs, healthcare data analysis, solution architecture, requirements gathering, data validation, and collaboration with business and technical stakeholders.
Responsibilities
- Support HEDIS measurement, reporting, validation, and annual submission activities
- Interpret HEDIS measure specifications and translate business requirements into data and reporting solutions
- Analyze HEDIS performance results and identify opportunities to improve quality scores and close care gaps
- Contribute to HEDIS solution architecture activities, including data flow design, integration approach, reporting architecture, and scalable data model recommendations
- Partner with technical architects and engineering teams to align HEDIS reporting requirements with platform capabilities, data governance standards, and long-term architecture decisions
- Partner with quality, population health, provider engagement, and care management teams to support HEDIS initiatives
- Assist with HEDIS audits, documentation reviews, and quality assurance activities
- Gather, analyze, document, and validate business requirements from health plan stakeholders
- Perform root cause analysis on data quality issues impacting HEDIS, CMS reporting, and operational performance
- Develop source-to-target mappings, business rules, process flows, and functional specifications
- Analyze large healthcare datasets and present findings, trends, and recommendations to business stakeholders
- Support UAT testing, reconciliation, defect resolution, and deployment validation activities
- Analyze claims, encounters, eligibility, provider, pharmacy, and supplemental data used for HEDIS and CMS reporting
- Validate data completeness, accuracy, reconciliation results, and reporting outputs
- Support CMS quality initiatives, STAR Ratings programs, and regulatory reporting requirements
- Collaborate with business and technical teams to improve reporting processes and data governance practices
- Understand payer operational workflows including claims processing, provider data, membership, enrollment, and quality management programs. Work directly with Huron consultants and client stakeholders to solve complex payer data challenges
- Facilitate requirements sessions, stakeholder interviews, and process reviews
- Translate technical findings into business recommendations and executive-level communications
- Support delivery of strategic payer transformation and data modernization initiatives
Skills
- • Bachelor's degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or related field
- • Additional relevant work experience in lieu of degree may be considered
- • 4–6+ years of healthcare payer, health plan, or managed care experience
- • Experience supporting solution design, architecture documentation, technical requirements, or data platform modernization efforts for HEDIS, quality reporting, or payer analytics solutions
- • Exposure to healthcare data architecture concepts, including source-to-target mapping, data lineage, integration design, reporting architecture, and scalable data model design
- • Strong hands-on HEDIS knowledge and experience supporting HEDIS reporting initiatives
- • Experience working within a Health Plan, Managed Care Organization, Medicare Advantage, Medicaid, or Commercial payer environment
- • Understanding of CMS regulations, CMS STAR Ratings, quality programs, and regulatory reporting requirements
- • Experience analyzing healthcare data including:
- • Claims
- • Encounters
- • Membership/Eligibility
- • Provider Data
- • Pharmacy Data
- • Supplemental Clinical Data
- • Strong business analysis skills including requirements gathering, process documentation, and stakeholder management
- • Advanced SQL experience for healthcare data analysis and validation
- • Experience performing data quality reviews, reconciliations, and root cause analysis
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