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Department

Hybrid Work Schedule

Job Summary

The Senior Data Analyst / HEDIS Technical Lead is responsible for the technical execution of the Healthcare Effectiveness Data and Information Set (HEDIS) program for Denver Health Medical Plan. Responsibilities will include data ingestion transformation validation run management and submissions. This role ensures that all HEDIS data is accurate complete traceable and audit-ready. This position plays a key role in driving performance improvement through rigorous data analytics identification of trends and opportunities and the development of actionable insights.
The Senior Analyst collaborates with clinical operational and technical teams as well as vendors and auditors to ensure accurate and timely reporting regulatory compliance and strategic execution of HEDIS initiatives across all product lines.

This role serves as the technical authority for how HEDIS is built executed and delivered working in close partnership with the HEDIS Program Lead and project management.

Essential Functions:

• Lead end-to-end HEDIS technical execution in accordance with NCQA technical specifications and regulatory timelines:
  Serves as subject matter expert on HEDIS data methodologies including Hybrid Administrative and Electronic Clinical Data Systems (ECDS) collection methods.
  Owns technical configuration and execution of HEDIS vendor platforms (e.g. Cotiviti):
  Manages test early production and production run sequencing
  Oversees ingestion of claims encounters enrollment provider and SDS data
  Ensures data integrity traceability and documentation of data flows
  Stay current on NCQA guidelines CMS and state-specific requirements and industry best practices. (40%)
• Management and incorporation of Supplemental Data Sources (SDS):
  Leads technical implementation of new and existing SDS
  Partners with business/clinical stakeholders to translate requirements into technical design
  Supports mapping validation PSV preparation and remediation
  Troubleshoots SDS-related issues during runs and audit
  (10%)
• Owns technical Quality Assurance and User Acceptance Testing including data loads and transformation measure output validation and variance analysis CAHPS sample generation and technical files. Responsible for confirmation that technical outputs align with specifications and business expectations
  (10%)
• File management and execution of submissions:
  Owns technical aspects of submissions including Cotiviti output files attest uploads NCQA IDSS technical files (XML/CSV) and State submissions as applicable
  Annual NCQA HEDIS ROADMAP HEDIS Audit IDSS and related data submissions including the closure of Issue Log items and performing benchmarking of collected data.
  Ensures submissions are complete timely and compliant (10%)
• Analyze HEDIS measure performance across Medicare Medicaid Exchange and Commercial lines of business; identify performance trends and root causes of underperformance. (10%)
• Partner with internal stakeholders such as Quality Improvement Population Health Clinical Operations HEDIS Team and IT to support interventions aimed at improving HEDIS outcomes and identifying additional sources to obtain data. (10%)
• Develop methods and workflows to improve data mapping and accuracy generation of performance reports identification of gaps in care and methods to identify new data sources including processes to assist in the transition to FHIR (Fast Healthcare Interoperability Resources) standards. (10%)

Education:

• Bachelors eegree public health Health Informatics Statistics Computer Science or a related field required
• Masters preferred

Work Experience:

• 4-6 years experience in health care data analytics with at least 3 years focused specifically on HEDIS or quality measurement reporting in a health plan or similar environment required
• 1-3 years strong SQL and data analysis skills including experience supporting data validation QA/UAT and/or audits required
• 1-3 years ability to communicate technical concepts to non-technical stakeholders and collaborate effectively across departments required

Licenses:

Knowledge Skills and Abilities:

• Strong knowledge of NCQA HEDIS specifications CMS Star Ratings and regulatory reporting to State and Federal programs.
• Direct experience with HEDIS software tools (e.g. Inovalon QSI-XL Cotiviti OnPoint or other vendors).
• In-depth knowledge of HEDIS lifecycle including NCQA IDSS submission formats and requirements.
• Familiarity with data from clinical systems (e.g. EMR/EHR) claims encounters and supplemental data sources.
• Experience supporting HEDIS audits and PSV processes.
• Excellent problem-solving communication multi-disciplinary collaboration and project management skills.
• Proficiency in Microsoft Office (Excel PowerPoint Word).
• Accuracy and attention to detail in data analysis and reporting.
• Proven ability to meet deadlines and manage deliverables.
• Ability to work independently and manage multiple competing priorities in a fast-paced environment.
• Experience working with Medicaid Exchange Medicare Advantage or Dual Eligible populations preferred
• Knowledge of risk adjustment care gaps or other quality-related initiatives such as CAHPS or Health Outcomes Survey (HOS) preferred
• Advanced proficiency with SQL (Oracle SQL Server or similar) with experience writing complex queries and optimizing data pipelines preferred
• Experience using reporting and data visualization tools (e.g. Tableau Power BI SAS R Python) preferred
• CPHQ (Certified Professional in Healthcare Quality) certification preferred

*This is a hybrid role with a requirement of being in the office 1-2 days per week.

Shift

Work Type

Salary

Benefits

• Outstanding benefits including up to 27 paid days off per year immediate retirement plan employer contribution up to 9.5% and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands travel and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test once a conditional offer of employment has been made.

Denver Health is an integrated high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center a 555-bed acute care medical center Denvers 911 emergency medical response system 10 family health centers 19 school-based health centers Rocky Mountain Poison & Drug Safety a Public Health Institute an HMO and The Denver Health Foundation.

As Colorados primary and essential safety-net institution Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community focusing on hiring and purchasing locally as applicable serving as a pillar for community needs and caring for more than 185000 individuals and 67000 children a year.

Located near downtown Denver Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.