HEDIS Data Analyst

Derex Technologies Inc • Newark, NJ

3d • Hybrid

About The Position

Derex Technologies Inc is seeking a HEDIS Data Analyst to join their team. This role involves developing and validating HEDIS measures, analyzing various healthcare datasets, and supporting annual submissions and audits. The analyst will also be responsible for data engineering tasks such as building SQL queries and ETL pipelines, improving data quality, and documenting data lineage. Additionally, the role includes managing chart reviews, collaborating with internal teams, and assisting with audit and compliance activities.

Requirements

• Advanced SQL (required)
• Experience with healthcare payer datasets (claims, eligibility, provider, EMR, pharmacy, lab)
• Knowledge of coding standards (ICD‑10, CPT, HCPCS, LOINC, NDC)
• Deep understanding of NCQA HEDIS specs
• Experience with hybrid & administrative measures
• Familiarity with audit processes, care gap workflows, and CMS Star Ratings

Responsibilities

• Develop/validate HEDIS measures per NCQA specs
• Analyze claims/eligibility/EHR/pharmacy/lab data
• Support annual HEDIS submissions, audits, and dashboards
• Build/optimize SQL queries, ETL pipelines, and data transformations
• Improve data quality
• Document data lineage and mappings
• Manage provider lists for chart review
• Validate chart abstraction
• Support outreach for care gaps
• Work with Quality, Clinical, Provider Relations, and Compliance teams
• Provide guidance on anomalies
• Present insights to leadership
• Assist with NCQA audit prep
• Ensure regulatory adherence
• Maintain audit trails and reporting artifacts

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed