Senior Data Analyst, HEDIS Technical Lead

Role Overview

• Lead end-to-end HEDIS technical execution in accordance with NCQA technical specifications and regulatory timelines
• Serves as subject matter expert on HEDIS data methodologies, including Hybrid, Administrative and Electronic Clinical Data Systems (ECDS) collection methods
• Owns technical configuration and execution of HEDIS vendor platforms (e.g., Cotiviti)
• 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
• Stay current on NCQA guidelines, CMS and state-specific requirements, and industry best practices.
• Management and incorporation of Supplemental Data Sources (SDS)
• Leads 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
• Owns technical Quality Assurance and User Acceptance Testing including data loads and transformation, measure output validation and variance analysis, CAHPS sample generation and technical files
• Responsible for confirmation that technical outputs align with specifications and business expectations
• File management and execution of submissions
• Analyzes HEDIS measure performance across Medicare, Medicaid, Exchange and Commercial lines of business; identify performance trends and root causes of underperformance
• Partner with internal stakeholders, such as Quality Improvement, Population Health, Clinical Operations, HEDIS Team and IT, to support interventions aimed at improving HEDIS outcomes and identifying additional sources to obtain data
• Develop methods and workflows to improve data mapping and accuracy, generation of performance reports, identification of gaps in care, and methods to identify new data sources, including processes to assist in the transition to FHIR (Fast Healthcare Interoperability Resources) standards.

Requirements

• Bachelor's degree public health, Health Informatics, Statistics, Computer Science, or a related field required
• 4-6 years experience in health care data analytics, with at least 3 years focused specifically on HEDIS or quality measurement reporting in a health plan or similar environment required
• 1-3 years strong SQL and data analysis skills including 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
• 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).

Tech Stack

• SQL

Benefits

• Outstanding benefits including up to 27 paid days off per year
• Immediate retirement plan employer contribution up to 9.5%
• Generous medical plans
• Free RTD EcoPass (public transportation)
• On-site employee fitness center and wellness classes
• Childcare discount programs & exclusive perks on large brands, travel, and more
• Tuition reimbursement & assistance
• Education & development opportunities including career pathways and coaching
• Professional clinical advancement program & shared governance
• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer