HEDIS Data Analyst / Business Analyst

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.

• 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.

Requirements

• Bachelor's degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or related field

• 4–6+ years of healthcare payer, health plan, or managed care experience.

• 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.

• Strong communication and presentation skills.