Senior Value-Based Healthcare Data Analyst - Remote

Optum is part of one of the nation's leading health care organizations, offering coordinated and accountable care through its multi-specialty clinic. The Senior Value-Based Healthcare Data Analyst will provide leadership and advanced analytical expertise to support healthcare quality and operational reporting initiatives, ensuring data accuracy and compliance with regulatory requirements.

Responsibilities:

• Providing leadership and advanced analytical expertise to support healthcare quality, regulatory, and operational reporting initiatives, including HEDIS, EDPS, and encounter submissions
• Ensuring accuracy, integrity, traceability, and compliance of complex, multi-source healthcare data in accordance with NCQA, CMS, and state regulatory requirements
• Functioning as a hands-on technical leader, supervising analytic activities and coordinating efforts across Quality, Clinical, Informatics, IT, and Business Intelligence teams
• Supporting organizational objectives related to quality performance, affordability, and improved member outcomes

Requirements:

• Bachelor's degree in Health Informatics, Healthcare Administration, Data Analytics, Statistics, Computer Science, Information Systems, Mathematics, or a related discipline
• 3+ years of experience in healthcare data analytics, informatics, decision support, or managed care, including project leadership or analyst mentoring
• Experience supporting NCQA HEDIS Compliance Audits, quality measurement, and value-based care programs
• Experience supporting Medicare Advantage (Part C) and/or Health Insurance Marketplace products
• Experience extracting, reconciling, and validating data from EPIC Clarity and/or Caboodle
• Solid experience with data validation, ETL processes, and healthcare reporting tools (eg, Tableau, Power BI, Crystal Reports)
• Knowledge of Medicare Advantage, including Stars, HEDIS, and regulatory reporting programs
• Advanced expertise in healthcare data analytics, quality measurement, and regulatory compliance
• Understanding of HEDIS Technical Specifications, NCQA requirements, and related compliance standards
• Proficiency working with claims and clinical data, including ICD 10 CM and CPT/HCPCS coding standards and healthcare data models
• Advanced proficiency in SQL and Microsoft Excel, with working knowledge of Word and PowerPoint
• Demonstrated ability to translate complex healthcare data into clear, executive level insights that support quality and performance strategy
• Demonstrated ability to manage multiple priorities in a fast paced, deadline driven environment
• Proven verbal and written communication skills with exceptional attention to detail and analytical rigor
• Proven independently monitors data pipelines, submissions, and measure results for anomalies, gaps, or logic errors
• Master's degree in health informatics, Data Science, Analytics, Biostatistics, Healthcare Administration, or related field
• Relevant certifications such as CPHQ, RHIA/RHIT, Epic (Clarity/Caboodle/reporting), CAP, or SAS/SQL/data analytics
• 3+ years of experience with EDI encounter data (837), acknowledgments (277CA/999), and CMS risk adjustment files (MAO 002/004, RAPS)
• Experience reviewing work and providing actionable feedback
• Solid expertise in healthcare analytics, quality metrics, and value-based care models
• Advanced knowledge of Epic Clarity architecture, refresh cycles, and EDW integration for BI/reporting
• Proficiency in Python, R, SAS, or similar programming/statistical tools
• Demonstrated ability to balance strategic thinking with hands-on execution
• Proven problem-solving skills with a focus on continuous improvement and proactive solution development