Expert Analyst - HEDIS

Job Description

The HEDIS Improvement Team supports quality improvement initiatives with a primary focus on Stars performance. The team partners closely with Clinical Operations to identify opportunities for improvement, develop actionable insights, and measure the impact of quality improvement initiatives.

Our analytics environment is built within a modern Informatics platform utilizing Databricks for data storage, transformation, and advanced querying. Team members leverage large-scale healthcare datasets, including claims, enrollment, provider, and clinical data, to drive data-informed decision making and improve member outcomes.

Preferred Qualifications

• Advanced experience working with healthcare data, including HEDIS data.
• Strong proficiency in SQL and/or SAS and experience developing complex queries against large healthcare datasets.
• Hands-on experience using Databricks for data exploration, transformation, and analytics.
• Familiarity with healthcare data sources such as claims, enrollment, provider, laboratory, and electronic health record (EHR) data.
• Experience building dashboards, reports, and analytical solutions using business intelligence tools such as Tableau.
• Demonstrated ability to translate complex analytical findings into actionable recommendations for business and clinical stakeholders.
• Knowledge of NCQA HEDIS specifications, CMS quality programs, and healthcare performance measurement methodologies.
• Assists in the design and implementation of epidemiologic studies to evaluate the effectiveness of clinical programs .
• Experience working in a collaborative, cross-functional environment and managing multiple priorities in a fast-paced setting.
• Experience with Python programming and automation within Databricks is considered a strong plus, particularly for streamlining data processes, improving efficiency, and developing scalable analytics solutions.
• Self-directed and adaptable, with the ability to manage multiple priorities, independently drive work forward, and quickly learn new tools, technologies, and business concepts in a dynamic environment.
• Strong problem-solving skills with a continuous improvement mindset, proactively identifying opportunities to enhance processes, efficiency, and analytical capabilities.

The Expert Analyst is responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that support prospective business decisions. This role also coordinates projects for senior management.

• Develops documentation, reports and presentations for all levels within the organization including executive leadership.
• Responsible for trend analysis, report development, ad-hoc analysis and support
• Develop and present complex analytics concisely for consumption by upper management and Executive leadership
• Design and implement epidemiologic studies to evaluate the effectiveness of clinical programs
• Ability to manage multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters
• Compile data from a variety of sources and conduct analytics using software including Excel, Oracle (SQL) and SAS to support business decisions
• Knowledge and experience with Medicare Advantage Stars and/or HEDIS data is a plus
• Ensures complete, accurate and timely data for reporting purposes.

EDUCATION

• Bachelor’s degree in Business Administration, Economics, Health Care, Information Systems, Statistics or a related field.
• Master’s Degree in Public Health, Epidemiology or other related field preferred.
• Continuous learning, as defined by the Company’s learning philosophy, is required.
• Certification or progress toward certification is highly preferred and encouraged.

Experience

Five (5) years of experience in a related field required to provide the necessary knowledge, skills, and abilities for the role.

Qualifications

• Strong communication skills are required to understand, interpret, and communicate ideas.
• Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
• Strong knowledge of data languages such as SAS or SQL
• Strong analytical, organizational, planning, and problem-solving skills.
• Ability to effectively interface with employees at all levels.
• Other related skills and/or abilities may be required to perform this job.
• Administer and adhere to corporate and departmental policies, practices and procedures.

PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $73,600 and $123,200.

EEO Statement: All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.

Candidates are hired on an "at will" basis. Nothing herein is intended to create a contract.