Data Analyst specializing in business strategy analysis, data exploration, and client interaction in a hybrid work environment.
About the role
- Senior HEDIS Data Analyst responsible for healthcare data analytics and compliance at Denver Health Medical Plan. Collaborating with teams to drive performance improvement and actionable insights in healthcare delivery.
Responsibilities
- Lead end-to-end HEDIS project data support, including data extraction, transformation, validation, and submission in accordance with NCQA technical specifications and regulatory timelines.
- Analyze HEDIS measure performance across Medicare, Medicaid, Exchange and Commercial lines of business; identify performance trends and root causes of underperformance.
- Present findings and recommended actions to leadership and stakeholder teams
- Partner with internal stakeholders, such as Quality Improvement, Population Health, Clinical Operations, HEDIS Team and IT, to support interventions aimed at improving HEDIS outcomes and identifying additional sources to obtain data.
- Design and develop dashboards and reports that provide actionable insights to both technical and non-technical audiences.
- Develop methods and workflows to improve data mapping and accuracy, generation of performance reports, identification of gaps in care, and methods to identify new data sources, including processes to assist in the transition to FHIR (Fast Healthcare Interoperability Resources) standards.
- Serve as primary data liaison external vendors and auditors to ensure completeness and accuracy of medical record review and supplemental data integration to support HSAG, HCPF, CMS, NCQA submissions.
- Responsible for timely submission of the Annual NCQA HEDIS ROADMAP, HEDIS Audit, IDSS and related data submissions including the closure of Issue Log items and performing benchmarking of collected data.
- Serves as subject matter expert on HEDIS data methodologies, including Hybrid, Administrative and Electronic Clinical Data Systems (ECDS) collection methods.
- Work with Denver Health and Hospital Authority to optimize data in structured data fields in Epic EHR to support ECDS
- Validate source system data and perform quality assurance checks to ensure data integrity for HEDIS and other quality reporting programs.
- Stay current on NCQA guidelines, CMS and state-specific requirements, and industry best practices.
- Support the development of standardized analytics tools and processes.
Requirements
- Bachelor's Degree public health, Health Informatics, Statistics, Computer Science, or a related field required
- Master’s degree preferred
- 4-6 years experience in health care data analytics, with at least 3 years focused specifically on HEDIS or quality measurement reporting in a health plan or similar environment required
- Strong knowledge of NCQA HEDIS specifications, CMS Star Ratings, and regulatory reporting to State and Federal programs.
- In-depth knowledge of HEDIS lifecycle, including NCQA IDSS tool usage.
- Familiarity with data from clinical systems (e.g., EMR/EHR), claims, encounters, and supplemental data sources.
- Excellent problem-solving, communication, multi-disciplinary collaboration and project management skills.
- Proficiency in Microsoft Office (Excel, PowerPoint, Word).
- Accuracy and attention to detail in data analysis and reporting.
- Proven ability to meet deadlines and manage deliverables.
- Ability to work independently and manage multiple competing priorities in a fast-paced environment.
- Experience with HEDIS software tools (e.g., Inovalon QSI-XL, Cotiviti, OnPoint, or other vendors), preferred
- Experience working with Medicaid, Exchange, Medicare Advantage, or Dual Eligible populations, preferred
- Knowledge of risk adjustment, care gaps, or other quality-related initiatives such as CAHPS or Health Outcomes Survey (HOS), preferred
- Advanced proficiency with SQL (Oracle, SQL Server, or similar), with experience writing complex queries and optimizing data pipelines, preferred
- Experience using reporting and data visualization tools (e.g., Tableau, Power BI, SAS, R, Python), preferred
- CPHQ (Certified Professional in Healthcare Quality) certification, preferred
Benefits
- Outstanding benefits including up to 27 paid days off per year
- Immediate retirement plan employer contribution up to 9.5%
- Generous medical plans
- Free RTD EcoPass (public transportation)
- On-site employee fitness center and wellness classes
- Childcare discount programs & exclusive perks on large brands, travel, and more
- Tuition reimbursement & assistance
- Education & development opportunities including career pathways and coaching
- Professional clinical advancement program & shared governance
- Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
- National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
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