Data Analyst

2 days ago

Piscataway NJ, United States ValueMomentum Full time

Role: HEDIS Data Analyst Location: 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.
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.
Produce and manage provider retrieve lists for medical record collection.
Support provider outreach related to missing documentation and care gaps.
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.
Assist with HEDIS Compliance Audit preparation and documentation.
Ensure adherence to NCQA guidelines and regulatory requirements.
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.

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