ValueMomentum
Role: HEDIS Data Analyst
Location: Piscataway, NJ
Key Responsibilities
- Must have HEDIS Analytics & Reporting
- Develop, validate, and maintain HEDIS measure calculations based on NCQA specifications.
- Extract, transform, and analyse data from claims, eligibility, EHR, pharmacy, and lab systems.
- Support annual HEDIS submissions, including numerator/denominator validation, audit documentation, and data quality checks.
- Conduct trending, gap analysis, and performance monitoring for all HEDIS measures.
- Generate weekly/monthly dashboards for stakeholder consumption.
- Data Engineering & ETL Support
- Develop and optimize SQL queries, ETL pipelines, and data transformations.
- Collaborate with IT/data engineering teams to improve data quality and resolve inconsistencies.
- Create field mappings, data lineage documentation, and technical specifications.
- Chart Review / Hybrid Measures
- Produce and manage provider retrieve lists for medical record collection.
- Validate chart abstraction output for accuracy and completeness.
- Support provider outreach related to missing documentation and care gaps.
- Cross-Functional Collaboration
- Partner with Quality Improvement, Clinical, Provider Relations, and Compliance teams to support initiatives.
- Provide guidance on data anomalies, measure interpretation, and technical HEDIS questions.
- Present insights and trend analyses to leadership.
- Audit & Compliance
- Assist with HEDIS Compliance Audit preparation and documentation.
- Ensure adherence to NCQA guidelines and regulatory requirements.
- Maintain audit trails and detailed reporting artifacts.
Technical Skills
- Advanced SQL (required).
- Experience working with healthcare payer datasets (claims, eligibility, provider, EMR, pharmacy, lab).
- Understanding of healthcare coding standards (ICD-10, CPT, HCPCS, LOINC, NDC).
HEDIS / Healthcare Domain Knowledge
- Deep understanding of NCQA HEDIS technical specifications.
- Experience with hybrid and administrative measures.
- Knowledge of HEDIS audit processes and regulatory timelines.
- Familiarity with care gap workflows and quality improvement strategies.