Senior HEDIS Technical Analyst
Senior HEDIS Technical Analyst
Posted on :
05-04-2025
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1 Vacancy
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Job Description
Join Martins Point Health Care an innovative notforprofit health care organization offering care and coverage to the people of Maine and beyond. As a joined force ofpeople caring for people Martins Point employees are on amission to transform our health care system while creating a healthier community. Martins Point employees enjoy an organizational culture of trust and respect where our values taking care of ourselves and others continuous learning helping each other and having fun are brought to life every day. Join us and find out for yourself why Martins Point has been certified as a Great Place to Work since 2015.
Position Summary
The Senior HEDIS Technical Analyst serves as a critical bridge between HEDIS technical specifications data infrastructure and business stakeholders. This role is responsible for translating complex HEDIS measure requirements into actionable data strategies writing TSQL queries to ensure accurate and efficient data extraction and transformations and reporting. This role collaborates with data engineers architects analysts and quality teams to optimize data builds validate measure calculations and support regulatory compliance.Key responsibilities include interpreting NCQA technical specifications troubleshooting data discrepancies enhancing automation processes and providing technical guidance on HEDISrelated data workflows. The ideal candidate possesses a strong background in healthcare quality measurement SQL server ETL processes data modeling and a deep understanding of claims clinical and administrative data sources.
This role plays a vital part in driving data integrity and operational excellence in HEDIS reporting ultimately supporting quality improvement initiatives and valuebased care success.
Job Description
Key Outcomes:
- Interprets creates processes and reports healthcare measures from various measure steward resources including but not limited to Centers for Medicare and Medicaid Services (CMS); National Committee for Quality Assurance (NCQA) and the Defense Health Agency (DHA).
- Translates licensed or documented metrics definitions into technical queries with appropriate cohorts and calculations
- Analyzes workflows and understand policies procedures and constraints of the clinical or business operations related to reporting requirements.
- Documents operational & report specifications.
- Performs complex quality assurance testing along with writing and executing queries for enhanced and complex medical data access.
- Plans develops and documents design and deployment processes workflows and results.
- Provides expertise in electronic clinical data capture and the development of electronic clinical data reporting and analysis.
- Oversees transition to digital quality and management of associated vendors
- Troubleshoots production reporting issues identify root causes and implement necessary coding updates.
- Validates data sources including Claims Electronic Health Data and Electronic Health Records for relevance integrity and accuracy. E.g. HL7 CCD.
- Strongs focus on working with peers as a team and ensuring documentation and training are thorough to allow for a smooth transition to the operations team.
- Quality assurance and controls of healthcare measures created and published for THC customers.
- Ensures proper use and protection of information assets by complying with the organizations information privacy and security policies to protect assets from unauthorized access and by reporting any security events or potential events or other security risks to the organization.
- Other duties and responsibilities as assigned.
Education/Experience:
- Bachelors degree in health sciences Masters degree preferred.
- 5 years of experience in the health care industry in HEDIS and/or quality improvement.
- Experience in managed care health services environment
- Experience programming HEDIS or HEDIS like measures.
- NCQA and HEDIS Experience.
Required License(s) and/or Certification(s):
- Certified Professional in Healthcare Quality preferred.
Skills/Knowledge/Competencies (Behaviors):
- Demonstrated knowledge of data collection transformation and quality assurance.
- Ability to extract cleanse integrate medical and pharmacy claims and membership data from various platforms and sources.
- Excellent communication organization and writing skills.
- Ability to effectively prioritize work multitask and achieve goals on time; work independently and to selfmotivate.
- Excellent critical thinking skills.
- Keen attention to detail.
- Ability to work effectively and collaboratively with internal and external stakeholders.
- Knowledge of and skills in data collection analysis and presentation.
- Excellent oral and written communication skills.
- Must demonstrate integrity sound judgement and strong interpersonal skills.
- Strong knowledge of medical terminology.
- Strong clinical knowledge and understanding of evidencedbased practice principles and the ability to define appropriate sources for standards of care.
- Must be able to address quality issues with tact and diplomacy.
- Proficient use of MS Office with a focus on Excel and report writing software.
- Proficiency in use of electronic medical records and computer applications.
- Ability to use data to make decisions.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martins Point Health Care Contact us at:
Required Experience:
Senior IC
Employment Type
Full-Time
Key Skills
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