[Remote] HEDIS Analyst

Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is hiring a HEDIS Analyst to manage, analyze, and interpret healthcare data for HEDIS reporting and quality improvement. The role leads HEDIS validation and submissions, develops reporting and analytics, and works with cross-functional teams to improve data accuracy and healthcare performance.

Responsibilities

• Lead HEDIS lifecycle validation and submission process
• Develop, maintain, and automate HEDIS measure reporting using SQL, Python, Data Bricks, or other analytical tools
• Analyze medical, pharmacy, and enrollment data as needed to validate HEDIS results
• Collaborate with internal and external customers to ensure data accuracy and completeness
• Support supplemental data integration and hybrid review process
• Perform root cause analysis on data quality issues and recommend process improvements
• Design dashboards and reports to track and trend HEDIS performance using Tableau and/or Power BI
• Provide analytical support for interventions aimed at improving HEDIS and STAR ratings performance
• Create visualizations and presentations to communicate findings to leadership and stakeholders
• Mentor analysts and provide technical and analytic guidance
• Lead and contribute data-driven projects that enhance quality reporting capabilities
• Stay current on NCQA specifications, CMS guidance, and healthcare analytics best practices

Skills

• 5+ years of experience in healthcare data analytics, with at least 2 years focused on HEDIS or quality measurement reporting is required
• Proficiency in SQL and or more analytics tools (Data Bricks, Python) is required
• Strong understanding of healthcare data structures (claims, eligibility, etc.)
• Excellent problem solving, analytical, and critical thinking skills
• Strong communication and presentation abilities-able to translate complex data into actionable insights
• High attention to detail and ability to manage multiple priorities in a fast-paced environment
• Bachelor's degree in data science, data analytics, or technology related field is preferred
• Experience with NCQA-certified HEDIS software is preferred
• Experience with HEDIS data submissions is preferred
• Familiarity with CMS STARs, CAHPS, HealthPlan Accreditation is preferred

Benefits

• Remote work options and hybrid work schedules
• Paid time off, including holidays and volunteer events
• Health insurance coverage for you and your dependents starting on Day 1
• 401(k)
• Tuition reimbursement
• Fully remote associates residing in states where service is required by contract, law, or regulation may submit for reimbursement.

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