Note: The job is a remote job and is open to candidates in USA. Huron is a global consultancy that helps healthcare organizations drive growth and enhance performance. They are seeking a HEDIS Data Analyst / Business Analyst to support HEDIS measurement, reporting, and validation activities while collaborating with various teams to improve quality scores and operational performance.
Responsibilities
- Support HEDIS measurement, reporting, validation, and annual submission activities
- Interpret HEDIS measure specifications and translate business requirements into data and reporting solutions
- Analyze HEDIS performance results and identify opportunities to improve quality scores and close care gaps
- Partner with quality, population health, provider engagement, and care management teams to support HEDIS initiatives
- Assist with HEDIS audits, documentation reviews, and quality assurance activities
- Gather, analyze, document, and validate business requirements from health plan stakeholders
- Perform root cause analysis on data quality issues impacting HEDIS, CMS reporting, and operational performance
- Develop source-to-target mappings, business rules, process flows, and functional specifications
- Analyze large healthcare datasets and present findings, trends, and recommendations to business stakeholders
- Support UAT testing, reconciliation, defect resolution, and deployment validation activities
- Analyze claims, encounters, eligibility, provider, pharmacy, and supplemental data used for HEDIS and CMS reporting
- Validate data completeness, accuracy, reconciliation results, and reporting outputs
- Support CMS quality initiatives, STAR Ratings programs, and regulatory reporting requirements
- Collaborate with business and technical teams to improve reporting processes and data governance practices
- Understand payer operational workflows including claims processing, provider data, membership, enrollment, and quality management programs. Work directly with Huron consultants and client stakeholders to solve complex payer data challenges
- Facilitate requirements sessions, stakeholder interviews, and process reviews
- Translate technical findings into business recommendations and executive-level communications
- Support delivery of strategic payer transformation and data modernization initiatives
Skills
- Bachelor's degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or related field. Additional relevant work experience in lieu of degree may be considered
- 4–6+ years of healthcare payer, health plan, or managed care experience
- Strong hands-on HEDIS knowledge and experience supporting HEDIS reporting initiatives
- Experience working within a Health Plan, Managed Care Organization, Medicare Advantage, Medicaid, or Commercial payer environment
- Understanding of CMS regulations, CMS STAR Ratings, quality programs, and regulatory reporting requirements
- Experience analyzing healthcare data including: Claims, Encounters, Membership/Eligibility, Provider Data, Pharmacy Data, Supplemental Clinical Data
- Strong business analysis skills including requirements gathering, process documentation, and stakeholder management
- Advanced SQL experience for healthcare data analysis and validation
- Experience performing data quality reviews, reconciliations, and root cause analysis
- Strong communication and presentation skills
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