Position DescriptionThis role is a senior level analyst responsible for powering all HEDIS improvement initiatives through advanced data analytics and insight generation. This role serves as the engine behind HEDIS strategy-owning the end-to-end analytical framework that identifies performance gaps, prioritizes opportunities, and quantifies the impact of interventions. This role requires a blend of deep Medicare/Stars HEDIS expertise, advanced analytics capability, and strong cross-functional leadership. The ideal candidate thrives in a fast-paced environment, uses data to influence decision-making, and consistently delivers measurable performance improvement.
Responsibilities and QualificationsAdvanced Analytics & Modeling- Lead the development of predictive models to identify members at risk of care gaps and prioritize outreach opportunities.
- Perform advanced statistical analyses to uncover drivers of HEDIS performance variation.
- Develop segmentation strategies (provider, population, geography) to target high-impact interventions.
- Design forecasting models to project HEDIS performance and simulate intervention scenarios.
Insight Generation & Strategic Influence- Translate complex analytical findings into clear, actionable recommendations for executive and operational stakeholders.
- Identify the highest-value opportunities for improvement based on impact, feasibility, and ROI.
- Serve as the primary advisor on HEDIS performance trends, risks, and opportunities.
Performance Measurement & ROI Analytics- Establish frameworks to measure the effectiveness of HEDIS interventions and initiatives.
- Conduct pre/post and longitudinal analyses to evaluate program impact.
- Quantify financial and quality outcomes, including Stars impact, incentive revenue, and cost of care implications.
Data Infrastructure & Reporting- Design and oversee enterprise HEDIS performance dashboards and reporting tools.
- Partner with Analytics and Reporting HEDIS Technical team to ensure data quality, integration, and accessibility.
- Automate reporting and insight generation to enable real-time performance monitoring.
Cross-Functional Partnership- Collaborate with Clinical, Quality, Provider Engagement, and Operations teams to align analytics with business needs.
- Enable stakeholders with data, tools, and insights to execute targeted improvement initiatives.
- Present findings and recommendations to senior leadership with clarity and influence.
HEDIS Expertise & Measure Optimization- Maintain deep expertise in HEDIS specifications, including hybrid and administrative measures.
- Identify opportunities to improve measure capture, coding accuracy, and documentation through analytics.
- Support audit readiness through data validation and performance reconciliation.
QualificationsRequired:- 7-10+ years of experience in healthcare analytics, HEDIS, or quality performance improvement.
- Advanced analytical skills, including experience with predictive modeling, statistical analysis, and large datasets.
- Demonstrated ability to translate data into actionable insights that drive measurable outcomes.
- Proficiency in data tools and programming languages (e.g., SQL, Python, R).
- Experience with data visualization tools (e.g., Tableau, Power BI).
Preferred:- Master's degree in Data Science, Public Health, Biostatistics, Healthcare Analytics, or related field.
- Experience with NCQA HEDIS measures and reporting processes.
- Familiarity with Medicare Stars, Medicaid quality programs, and value-based care models.
- Experience working with claims, EHR, and supplemental data sources.
