HEDIS Data Analyst

• W2 only- NO C2C or 3rd Party resumes

Job Description:

We are seeking a HEDIS Technical Lead to serve as the technical owner of HEDIS outputs from the HEDIS Engine, ensuring accuracy, completeness, and audit readiness of all measure results. This individual will partner closely with the HEDIS Clinical Lead to interpret new measure specifications and drive the end-to-end execution of HEDIS measurement, validation, and submission activities. The ideal candidate will have hands-on experience managing HEDIS production cycles within Cotiviti or similar vendor platforms, validating measure outputs, supporting audits, and managing NCQA IDSS submissions.

Responsibilities:

• Serve as the Technical Lead for HEDIS production and submission lifecycle activities.

• Partner with the Clinical Lead to develop and execute HEDIS program strategies.

• Manage test, early production, and production run sequencing.

• Oversee ingestion and validation of claims, encounters, enrollment, provider, and supplemental data source (SDS) files.

• Ensure data integrity, traceability, and documentation of data flows within the HEDIS Engine.

• Collaborate with HEDIS Engine vendor teams to resolve technical issues in a timely manner.

• Partner with Clinical and IT teams to implement and maintain supplemental data sources.

• Translate business and clinical requirements into technical solutions and designs.

• Support mapping, validation, primary source verification (PSV), preparation, and remediation efforts.

• Troubleshoot supplemental data source issues during production runs and audits.

• Lead technical QA/UAT activities, including measure output validation, variance analysis, and CAHPS sample generation.

• Validate technical outputs against HEDIS specifications and business requirements.

• Manage technical aspects of submissions, including Cotiviti output files, attest uploads, NCQA IDSS XML/CSV files, and state reporting submissions.

• Ensure all submissions are complete, timely, and compliant with regulatory requirements.

• Provide technical evidence and analysis for audit requests.

• Perform root cause analysis for discrepancies and audit findings.

• Maintain technical documentation supporting audit readiness, business continuity, and operational excellence.

• Perform other duties as assigned.

• Comply with all company policies, procedures, and standards.

Requirements:

• 4–6 years of healthcare data analytics experience, including at least 3 years of HEDIS-focused technical experience within a health plan or similar environment.

• 1–3 years of experience supporting data validation, QA/UAT processes, and/or audits.

• Strong ability to communicate technical concepts to non-technical stakeholders and collaborate across departments.

• Strong SQL and data analysis skills.

• In-depth knowledge of NCQA HEDIS specifications and HEDIS measurement methodologies.

• Experience with HEDIS software tools such as Cotiviti, Inovalon QSI-XL, OnPoint, or similar vendor platforms.

• Knowledge of NCQA IDSS submission requirements and file formats.

• Experience working with claims, encounters, enrollment, provider, EHR/EMR, and supplemental data sources.

• Experience supporting HEDIS audits and PSV processes.

• Strong analytical, problem-solving, communication, and project management skills.

• Proficiency with Microsoft Office applications including Excel, PowerPoint, and Word.

• Demonstrated attention to detail and ability to manage multiple priorities in a fast-paced environment.

Key Skills:

• HEDIS Technical Leadership

• Cotiviti HEDIS Engine

• NCQA HEDIS Specifications

• NCQA IDSS Submissions

• HEDIS Production Management

• Healthcare Data Analytics

• SQL Development and Data Analysis

• QA/UAT Testing

• Supplemental Data Sources (SDS)

• Audit Support and PSV

• Root Cause Analysis

• CAHPS Technical Support

• Regulatory Reporting

• Cross-Functional Collaboration

• Project Management

Preferred Qualifications:

• Experience working with Medicaid, Medicare Advantage, Exchange, or Dual Eligible populations.

• Knowledge of risk adjustment, care gaps, CAHPS, Health Outcomes Survey (HOS), or other quality improvement initiatives.

• Advanced SQL proficiency across Oracle, SQL Server, or similar databases.

• Experience with Tableau, Power BI, SAS, R, Python, or other reporting and visualization tools.

Pay Range:

$ 40-60/hr

Benefits:

Our comprehensive benefits package includes:

o Medical insurance

o Dental insurance

o Vision insurance

o 401(k) retirement savings plan

Contact:

Karrie Ruch

kruch@jacobsongroup.com

Refer a Colleague:

Do you know someone who may be interested in this opportunity? Please email their contact information to Karrie Ruch at kruch@jacobsongroup.com or submit a referral through our referral program. If your referral is successfully placed, you may be eligible for a referral bonus.

Equal Opportunity Employer:

We are an Equal Opportunity Employer and are committed to creating an inclusive environment for all employees. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected status. If you require a reasonable accommodation during the application process, please contact HR@jacobsononline.com or call 1 (800) 466-1578.