Advisory Services Senior HEDIS Consultant - Remote

UnitedHealth Group•Eden Prairie, MN

10h•$91,700 - $163,700•Remote

About The Position

The Advisory Services Senior Consultant provides deep expertise in HEDIS data, analytics, quality measures, and CMS Medicare Stars performance, assisting organizations in ensuring compliance and improving outcomes for Medicare Advantage and other health plan populations. Responsibilities typically include data analysis, HEDIS data validation, NCQA and state specific submissions, CMS Star Ratings measure support, user acceptance testing, and developing client-facing reports and recommendations. This role requires solid analytical skills, knowledge of healthcare systems, coding (ICD, CPT), Medicare quality measurement, and experience with tools like SQL, PowerBI, and Excel. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Requirements

3+ years of experience with healthcare claims analysis
3+ years of experience; skilled in reading and writing moderate to complex SQL commands and accurately assessing results
3+ years of experience with analyzing HEDIS metrics or working as a Functional SME for HEDIS reporting
Experience supporting Medicare Advantage quality performance, CMS Medicare Star Ratings measures, or Stars-related performance improvement initiatives
Experience in a client facing role
Proven ability to write clearly composed documentation for business requirements, as well as information that will be distributed to auditors
Proven ability to solve problems, including multiple priorities and researching conflicting and/or inaccurate data
Ability to travel up to 40%25 of the time (Typically out on Sunday/Monday with return home on Thursday - or shorter trips - as business needs dictate)

Nice To Haves

Experience with HEDIS vendor software a plus or experience with HEDIS reporting using other tools
Experience gathering requirements from the client/business and documenting
Experience with process improvement, workflow, benchmarking, and/or evaluation of business processes
SSIS ETL development experience
Project management experience
Working knowledge of relational databases, database structures
Intermediate level of proficiency with PC-based software programs and automated database management systems (Excel, Access, PowerPoint)

Responsibilities

Serve as a client-facing HEDIS consulting resource, partnering with health plan clients to understand quality reporting objectives, operational needs, and measure-specific requirements
Analyze, validate, and interpret complex healthcare data, including claims, enrollment, provider, supplemental, and clinical data used to support HEDIS measure reporting
Support HEDIS data validation, measure rate review, gap identification, and quality improvement analyses to help clients improve performance and meet reporting expectations
Apply a CMS Medicare Stars lens to HEDIS measure analysis, identifying performance drivers, measure gaps, cut-point considerations, and opportunities to improve Medicare Advantage Star Ratings outcomes
Translate HEDIS specifications, NCQA guidance, state requirements, and client business needs into actionable reporting, analytic, and operational recommendations
Connect HEDIS results, CAHPS/HOS considerations, clinical quality outcomes, and CMS Star Ratings methodology to actionable client strategies for quality improvement and reporting readiness
Develop and document business requirements, data mapping, validation results, issue logs, and client-facing deliverables for HEDIS reporting and audit readiness
Use SQL, Excel, PowerBI, and related analytic tools to research data questions, assess measure logic, reconcile results, and support reporting accuracy
Lead or support user acceptance testing, defect triage, root cause analysis, and resolution planning for HEDIS reporting processes and vendor or internal reporting platforms
Facilitate client discussions, communicate findings clearly, and provide consultative recommendations on difficult data, reporting, and quality measurement issues
Identify opportunities to improve HEDIS reporting workflows, data quality controls, documentation, and repeatable processes across client engagements
Manage assigned consulting workstreams with minimal guidance, balancing priorities, timelines, client expectations, and issue resolution needs
Coach, guide, and act as a resource for team members