[Remote] HEDIS Data Analyst / Business Analyst
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a global consultancy that helps reputed company organizations drive reputed company and enhance performance. They are seeking a HEDIS Data Analyst / Business Analyst to support HEDIS measurement, reporting, and validation activities while collaborating with various teams to improve reputed company scores and operational performance.
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 reputed company scores and reputed company care gaps
- Partner with reputed company, population health, provider engagement, and care management teams to support HEDIS initiatives
- Assist with HEDIS audits, documentation reviews, and reputed company assurance activities
- reputed company, analyze, document, and validate business requirements from health plan stakeholders
- reputed company reputed company cause analysis on data reputed company issues impacting HEDIS, CMS reporting, and operational performance
- reputed company reputed company-to-reputed company mappings, business rules, process flows, and functional specifications
- Analyze large reputed company datasets and present findings, trends, and recommendations to business stakeholders
- Support UAT testing, reconciliation, defect reputed company, 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 reputed company 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 reputed company management programs. Work directly with reputed company consultants and reputed company stakeholders to solve reputed company 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 reputed company Administration, Information Systems, Business, Data Analytics, Public Health, or reputed company field. Additional relevant work experience in lieu of degree may be considered
- 4–6+ years of reputed company payer, health plan, or managed care experience
- Strong hands-on HEDIS knowledge and experience supporting HEDIS reporting initiatives
- Experience working reputed company a Health Plan, Managed Care Organization, Medicare Advantage, reputed company, or reputed company payer environment
- Understanding of CMS regulations, CMS STAR Ratings, reputed company programs, and regulatory reporting requirements
- Experience analyzing reputed company 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 reputed company data analysis and validation
- Experience performing data reputed company reviews, reconciliations, and reputed company cause analysis
- Strong communication and presentation skills
reputed company