Senior HEDIS Technical Analyst - Remote

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond.  As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community.  Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day.  Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
 

Position Summary
 

The Senior HEDIS Technical Analyst serves as a critical bridge between HEDIS technical specifications, data infrastructure, and business stakeholders. This role is responsible for translating complex HEDIS measure requirements into actionable data strategies, writing T-SQL queries to ensure accurate and efficient data extraction and transformations, and reporting. This role collaborates with data engineers, architects, analysts, and quality teams to optimize data builds, validate measure calculations, and support regulatory compliance.

Key responsibilities include interpreting NCQA technical specifications, troubleshooting data discrepancies, enhancing automation processes, and providing technical guidance on HEDIS-related data workflows. The ideal candidate possesses a strong background in healthcare quality measurement, SQL server, ETL processes, data modeling, and a deep understanding of claims, clinical, and administrative data sources.

This role plays a vital part in driving data integrity and operational excellence in HEDIS reporting, ultimately supporting quality improvement initiatives and value-based care success.

Job Description

Key Outcomes:

• Interprets, creates, processes, and reports healthcare measures from various measure steward resources including but not limited to Centers for Medicare and Medicaid Services (CMS); National Committee for Quality Assurance (NCQA) and the Defense Health Agency (DHA).
• Translates licensed or documented metrics definitions into technical queries with appropriate cohorts and calculations
• Analyzes workflows and understand policies, procedures, and constraints of the clinical or business operations related to reporting requirements.
• Documents operational & report specifications.
• Performs complex quality assurance testing along with writing and executing queries for enhanced and complex medical data access.
• Plans, develops, and documents design and deployment processes, workflows, and results.
• Provides expertise in electronic clinical data capture and the development of electronic clinical data reporting and analysis.
• Oversees transition to digital quality and management of associated vendors
• Troubleshoots production reporting issues, identify root causes and implement necessary coding updates.
• Validates data sources, including Claims, Electronic Health Data, and Electronic Health Records, for relevance, integrity, and accuracy. E.g., HL7, CCD.
• Strongs focus on working with peers as a team and ensuring documentation and training are thorough to allow for a smooth transition to the operations team.
• Quality assurance and controls of healthcare measures created and published for THC customers.
• Ensures proper use and protection of information assets by complying with the organization’s information privacy and security policies to protect assets from unauthorized access and by reporting any security events or potential events or other security risks to the organization.
• Other duties and responsibilities, as assigned.

Education/Experience:

• Bachelor’s degree in health sciences, Master’s degree preferred.
• 5+ years of experience in the health care industry, in HEDIS and/or quality improvement.
• Experience in managed care health services environment
• Experience programming HEDIS or HEDIS like measures.
• NCQ