Senior HEDIS Data Analyst

Company Description

SpectraMedix is a leading healthcare analytics organization dedicated to empowering health plans and providers in their transition to value-based care. Our VBP Analytics Suite offers actionable insights into quality, risk, utilization, and financial performance, enabling stakeholders to execute intricate value-based arrangements effectively.

Job Title: Senior HEDIS Data Analyst
Location: East Windsor, NJ (Hybrid)
Experience Level: 6–8 Years
Employment Type: Full-time

Job Description

Role Overview

We are seeking a seasoned HEDIS Data Analyst with robust experience in healthcare data analytics, particularly within the payer and health plan sector. The ideal candidate will possess a deep understanding of HEDIS measures and a strong background in value-based care analytics, including utilization management, member attribution, financial risk assessment, and performance analysis.

Key Responsibilities

• HEDIS and Quality Measure Analysis: Analyze and report on HEDIS measures and other payer quality programs (e.g., Stars, QRS, MIPS) to support NCQA reporting and performance improvement efforts.
• Utilization and Cost Analysis: Perform advanced claims data analysis to uncover insights in member utilization patterns, service gaps, care quality, and preventable events.
• Member Attribution and Risk Adjustment: Support member attribution logic, provider performance evaluation, and population segmentation.
• Financial Performance Analytics: Conduct financial performance analysis on risk-adjusted populations, including tracking cost-of-care trends, capitation, risk-sharing arrangements, and shared savings opportunities.
• Cross-Functional Collaboration: Collaborate with actuarial, care management, provider contracting, and quality teams to align analytics with health plan business objectives.
• Data Modeling and Reporting: Translate healthcare business needs into data models and actionable KPIs using SQL, dashboards (e.g., Tableau), and written reports.
• Compliance and Data Integrity: Ensure integrity and compliance with NCQA, CMS, and HIPAA regulations in all data-related activities.

Qualifications

• Experience: 6–8 years of experience in data analytics within a health plan, payer, or managed care environment.
• Technical Proficiency: Strong command of SQL for querying large healthcare datasets (claims, enrollment, provider, EMR).
• Healthcare Knowledge: Deep understanding of US healthcare ecosystem including Medicare, Medicaid, and commercial payers.
• Coding Systems: Proficiency in standard healthcare coding systems: ICD-10, CPT, HCPCS, DRG, MDC, etc.
• Quality Measures: Experience with clinical quality measures such as HEDIS, eCQMs, PQIs, PDIs.
• Data Visualization: Proficiency in data visualization tools like Tableau or Power BI for creating executive-ready dashboards and operational reporting.
• Education: Bachelor’s or Master’s degree in Public Health, Health Administration, Health Informatics, Statistics, or a related field.

Additional Information

Preferred Experience

• Value-Based Care Analytics: Experience with value-based care models and payer quality programs (MIPS, ACO, DSRIP).
• Financial Modeling: Familiarity with CMS financial models, risk corridors, or capitated payment analytics.
• Care Management Analytics: Exposure to care management analytics, disease management, or population health programs.
• Actuarial Collaboration: Experience in working with actuarial or finance teams to model performance under VBC contracts.

Core Competencies

• Analytical Skills: Strong analytical and problem-solving abilities.
• Communication: Excellent communication skills (verbal and written), especially with non-technical stakeholders.
• Independence: Self-starter who thrives in a fast-paced, dynamic environment.
• Teamwork: Strong team player with the ability to lead initiatives independently.

**//Ready to bring clarity to complex healthcare data and support smarter decision-making in health plans? Apply now and be a catalyst for data-driven transformation in value-based care.//**