The Senior Value-Based Healthcare Data Analyst is responsible for providing leadership and advanced analytical expertise to support healthcare quality, regulatory, and operational reporting initiatives, including HEDIS, EDPS, and encounter submissions. This position ensures accuracy, integrity, traceability, and compliance of complex, multi-source healthcare data in accordance with NCQA, CMS, and state regulatory requirements. The role functions as a hands-on technical leader, supervising analytic activities and coordinating efforts across Quality, Clinical, Informatics, IT, and Business Intelligence teams. Through collaboration and data-driven insights, the position supports organizational objectives related to quality performance, affordability, and improved member outcomes.
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- Bachelor's degree in health informatics, Healthcare Administration, Data Analytics, Statistics, Computer Science, Information Systems, Mathematics, or related discipline
- 3+ years of experience in healthcare data analytics, informatics, decision support, or managed care, including project leadership or analyst mentoring
- Hands-on experience supporting Medicare Advantage (Part C) and/or Health Insurance Marketplace products
- Experience supporting NCQA HEDIS Compliance Audits, quality measurement, and value-based care programs
- Demonstrated experience extracting, reconciling, and validating data from EPIC Clarity and/or Caboodle
- Solid experience with data validation, ETL processes, and healthcare reporting tools (e.g., Tableau, Power BI, Crystal Reports)
- Deep knowledge of Medicare Advantage, including Stars, HEDIS, and regulatory reporting programs
- Thorough understanding of HEDIS Technical Specifications, NCQA requirements, and related compliance standards
- Advanced proficiency in SQL and Microsoft Excel, with working knowledge of Word and PowerPoint
- Solid proficiency working with claims and clinical data, including ICD-10-CM and CPT/HCPCS coding standards and healthcare data models
- Proven ability to proactively identify and communicate risks, delays, data issues, and recommended solutions to stakeholders
- Proven ability to independently monitor data pipelines, submissions, and measure results for anomalies, gaps, or logic errors
Preferred Qualifications:- Master's degree in health informatics, Data Science, Analytics, Biostatistics, Healthcare Administration, or a related field
- Certified Professional in Healthcare Quality (CPHQ)
- Registered Health Information Administrator (RHIA) or (RHIT)
- Epic certification (Clarity, Caboodle, or reporting modules)
- Certified Analytics Professional (CAP)
- SAS, SQL, or data analytics-related certifications
- 3+ years of experience with EDI encounter data (837), acknowledgments (277CA/999), and CMS risk adjustment files (MAO-002, MAO-004, RAPS)
- Experience reviewing others' work and providing constructive recommendations for improvement
- Advanced familiarity with EPIC Clarity architecture, refresh cycles, and enterprise data warehouse integration supporting BI and reporting environments
- Solid background in healthcare analytics, quality metrics, and advanced value-based care models
- Proficiency with Python, R, SAS, or similar statistical or programming languages
- Demonstrated ability to balance strategic perspective with hands-on technical execution
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
