HEDIS Data Analyst

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