Senior HEDIS Analyst/ Technical Lead - Denver Health Medical Plan ( *Must Live in Colorado. On-Site Requirement* )

We are recruiting for a mission-driven Senior HEDIS Analyst/ Technical Lead - Denver Health Medical Plan ( *Must Live in Colorado. On-Site Requirement* ) to join our team!

We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey.

Our Values

Respect | Belonging | Accountability | Transparency

Department

Managed Care Administration

*Must Live in Colorado

* This is a hybrid position with a requirement of being on-site 2 days per week in Denver, Colorado.

Job Summary

This position serves as the technical owner of Healthcare Effectiveness Data and Information Set (HEDIS) outputs from the HEDIS Engine, ensuring accuracy, completeness, and audit readiness of all measure results and working with the HEDIS Clinical Lead to interpret new measure specifications.

The HEDIS Technical Lead is responsible for end-to-end execution of HEDIS measurement, validation, and submission, with a primary focus on HEDIS Engine (Cotiviti) production, rate validation, and NCQA IDSS submission for Denver Health Medical Plan (DHMP). The ideal candidate has hands-on experience running HEDIS cycles in Cotiviti (or similar vendor platforms), validating measure outputs, and managing IDSS submissions, and can partner effectively with data warehouse and clinical team. This role ensures that all HEDIS data is accurate, complete, traceable, and audit-ready.

Essential Functions:

• HEDIS Technical Execution
  • Serves as Technical Lead on HEDIS Production and Submission Lifecycle
  • Partners with Clinical Lead for strategy development of HEDIS Program
  • Manages test, early production, and production run sequencing
  • Oversees ingestion of claims, encounters, enrollment, provider, and SDS data
  • Ensures data integrity, traceability, and documentation of data flows within the HEDIS Engine
  • Works directly with HEDIS Engine staff to ensure issues are resolved timely
  (40%)
• Supplemental Data Sources (SDS)
  • Partner with Clinical Lead and internal IT Teams for technical implementation of new and existing SDS
  • Partners with business/clinical stakeholders to translate requirements into technical design
  • Supports mapping, validation, PSV preparation, and remediation
  • Troubleshoots SDS-related issues during runs and audit (20%)
• QA / UAT (Technical)
  • Owns technical QA/UAT for:
  o Measure output validation and variance analysis
  o CAHPS sample generation and technical files
  • Confirms technical outputs align with HEDIS specifications and business expectations (10%)
• Submissions & File Management
  • Owns technical aspects of submissions, including:
  o Cotiviti output files
  o Attest uploads
  o NCQA IDSS technical files (XML/CSV)
  o State submissions, as applicable
  • Ensures submissions are complete, timely, and compliant (20%)
• Audit & Issue Resolution
  • Provides technical evidence and analysis for audit requests
  • Performs root cause analysis for discrepancies or findings
  • Maintains technical documentation to support audit defense and continuity
  (10%)

Education:

• Bachelor’s degree in data analytics, information systems, computer science, or related field required

Work Experience:

• 4-6 years experience in health care data analytics, with at least 3 years focused specifically on HEDIS-specific technical experience in a health plan or similar environment required
• 1-3 years Experience supporting data validation, QA/UAT, and/or audits Required
• 1-3 years ability to communicate technical concepts to non-technical stakeholders and collaborate effectively across departments required
• 1-3 years strong SQL and data analysis skills required

Licenses:

Knowledge, Skills and Abilities:

• Strong knowledge of NCQA HEDIS specifications, CMS Star Ratings, and regulatory reporting to State and Federal programs.
• Direct experience with HEDIS software tools (e.g., Inovalon QSI-XL, Cotiviti, OnPoint, or other vendors).
• In-depth knowledge of HEDIS lifecycle, including NCQA IDSS submission formats and requirements.
• Familiarity with data from clinical systems (e.g., EMR/EHR), claims, encounters, and supplemental data sources.
• Experience supporting HEDIS audits and PSV processes.
• Excellent problem-solving, communication, multi-disciplinary collaboration and project management skills.
• Proficiency in Microsoft Office (Excel, PowerPoint, Word).
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