HEDIS Data Quality Integrity Analyst

Horizon Blue Cross Blue Shield of New Jersey•Hopewell, NJ

1d•$109,600 - $149,625

About The Position

This technical lead designs and carries out quality analytics, implementing a structured approach to data quality so HEDIS data accurately reflects members’ health status. The role collaborates across the enterprise to lead quality performance analytics, development, and reporting that produce actionable insights. As a subject matter expert, the analyst gathers requirements based on State, CMS, and NCQA specifications; translates them into analytics and data specifications; manipulates and analyzes large healthcare datasets from various sources; and interprets findings to identify opportunities and solutions that improve clinical quality, cost efficiency, and healthcare affordability. The position requires advanced analytic programming and coding skills and a strong understanding of healthcare business and data.

Requirements

High school diploma or GED.
At least 5 years of experience in data analytics, HEDIS, SAS, or a related field.
At least 5 years of experience analyzing healthcare data, HEDIS data, or relational healthcare databases, including significant experience analyzing medical, pharmacy, and behavioral data.
Extensive knowledge of the US healthcare industry, health plan business, claims data, clinical data, and coding practices.
Proficiency with MS Excel for data analysis and reporting.
Strong organizational skills and attention to detail.
Ability to work in a fast-paced, team-oriented environment and manage competing priorities.
Highly motivated and able to work independently.

Nice To Haves

Bachelor’s degree in Math, Statistics, Data Science, or Public Health, or relevant experience in lieu of a degree.
Knowledge and working experience with visualization and business intelligence tools such as Tableau; Tableau experience is preferred.
SAS, SQL, and Python experience is strongly preferred.

Responsibilities

Lead implementation of projects designed to improve HEDIS, Stars, accreditation, and State performance.
Own vendor relationships for vendors engaged to improve quality performance.
Build quality assurance criteria and processes to ensure regulatory reporting data is complete and accurate.
Act as the analytic liaison for complex clinical analytics projects involving multiple data resources and teams, informing business decisions in clinical, network, and value-based performance models.
Understand organizational strategic direction and analytic and reporting requirements, and translate business needs into technical analytics requirements and designs.
Create integrated analytic datasets and summarize findings to inform business opportunities and address business questions.
Explain analytic findings, including root causes and contributing factors, through clear written and oral summaries, tables, charts, reports, or presentations.
Coordinate across analytical and business units to communicate analytics design, results, and interpretation, and recommend how findings can inform business decisions.
Document methods, specifications, and findings; collaborate on project documentation, including SAS coding comments and analytic plans or timelines where needed.
Present analytics findings to internal leadership teams to inform actionable opportunities and solutions.
Provide technical training to junior analysts in analytics design, data, programming, quality assurance, statistics, and documentation.