Role: HEDIS Data Analyst
Location: Newark, NJ or nearby (remote, 2–4 days/month onsite)
Key Responsibilities:
· HEDIS Analytics → Develop/validate HEDIS measures per NCQA specs, analyze claims/eligibility/EHR/pharmacy/lab data, support annual submissions, audits, and dashboards.
· Data Engineering → Build/optimize SQL queries, ETL pipelines, and data transformations; improve data quality; document lineage and mappings.
· Chart Review → Manage provider lists, validate chart abstraction, support outreach for care gaps.
· Collaboration → Work with Quality, Clinical, Provider Relations, and Compliance teams; provide guidance on anomalies; present insights to leadership.
· Audit & Compliance → Assist with NCQA audit prep, ensure regulatory adherence, maintain audit trails and reporting artifacts.
Technical Skills:
· Advanced SQL (required)
· Experience with healthcare payer datasets (claims, eligibility, provider, EMR, pharmacy, lab)
· Knowledge of coding standards (ICD‑10, CPT, HCPCS, LOINC, NDC)
Domain Knowledge:
· Deep understanding of NCQA HEDIS specs
· Experience with hybrid & administrative measures
· Familiarity with audit processes, care gap workflows, and CMS Star Ratings