Senior Business Systems Analyst

Job Description

Utilizing strong functional/technical area knowledge and expertise with relevant systems/applications. The incumbent defines evaluates and validates requirements business functional design and technical design for complex business issues within their domain areas. They act as a liaison representing their department and the processes and workings within it to develop effective technical solutions and minimize operational and system/application impacts. Coordinates with IT to support problem resolution testing software upgrades and related projects of a more complex nature.

This is a HEDIS Data Management and Production Operations role not a Business Intelligence or reporting-focused position. The ideal candidate will have direct experience managing monthly HEDIS data loads data quality validation production support vendor data integration and cross-functional delivery of HEDIS initiatives in partnership with ETL and Data Engineering teams.

What Youll Do

• Serve as the primary data management lead for the monthly HEDIS production process owning the end-to-end intake loading validation reconciliation and certification of HEDIS data from multiple internal and external sources.
• Demonstratedeep knowledge of the monthly HEDIS data load lifecycle including claims enrollment pharmacy provider laboratory EMR supplemental and vendor data ingestion processes and ensure successful execution of monthly quarterly and annual production schedules.
• Develop andmaintainSQL queries data mappings and integrations to support HEDIS quality metrics including advanced data mapping across claims clinical vendor supplemental and FHIR-based data sources.
• Independently drive HEDIS data initiatives from requirements through implementation partnering with IT ETL data engineering vendors and business stakeholders to ensure successful delivery of solutions.
• Perform monthly loading validation reconciliation and monitoring of the HEDIS data management pipeline ensuringtimelyandaccurateingestion of all required source data and proactive resolution of data quality issues.
• Lead data quality investigations and root cause analysis related to HEDIS rates member eligibility measure compliance claims lag supplemental data integration and vendor feed discrepancies.
• Ensure the accuracy completeness and reliability of datautilizedin quality management and support downstream reporting audit analytics and regulatory submissions.
• Collaborate with cross-functional teams to define HEDIS data requirements and implement process improvements that expand and integrate new data sources including vendor feeds EMR data digital quality measures and FHIR APIs.
• Analyze HEDIS production data trends including membership growth/attrition claims lag encounter volumes vendor submissions and supplemental data performance providing actionable recommendations to leadership.
• Develop test andmaintainprocesses supporting ingestion and management of supplemental clinical data sources including EMR Laboratory CCDA Immunization Registry Medical Records FHIR APIs and vendor submissions
• Monitorand reconcile monthly vendor data loads toidentifygaps anomalies unexpected volume changes mapping issues or data quality concerns; coordinate resolution efforts with vendors and internal technical teams.
• Partner closely with ETL and Data Engineering teams to define requirements validatetransformations troubleshoot production issues and ensure delivery of reliable HEDIS data assets.
• Support HEDIS audits byvalidatingsource data responding to auditor requests documenting data lineage and ensuring readiness of both traditional and supplemental data sources.
• Maintaindetailed documentation of data flows mappings transformation rules vendor dependencies and production processes to support knowledge transfer governance and audit readiness.
• Validateannual HEDIS software upgrades specification updates vendor enhancements and data source changes to ensure production readiness and measure integrity.
• Develop and maintain SQL queries data mappings and integrations to support HEDIS quality metrics including strong data mapping skills across claims clinical vendor and FHIR based data sources.

What You Bring

• Bachelors degree or advanced degree (where required)

• 5 years of experience in related field

• In lieu of degree 7 years of experience in related field

• Proven experience as an Analyst preferably in quality data management HEDIS reporting or a related healthcare analytics role.

• Proficient in programming languages such as SQL Python R or similar.

• Experience with data management systems and tools (e.g. SQL databases ETL tools data visualization software).

• Strong familiarity with FHIR standards (US Core QICore) digital quality measure (dQM) interpretation and robust data mapping across claims clinical and vendor data sources.

• Experience performing recurring (monthly) data loads monitoring production pipelines and trend analysis across membership and claims data.

• Strong analytical skills with attention to detail and ability to identify data anomalies trends and root causes.

• Familiarity with quality control processes and standards (ISO Six Sigma etc.) is a plus.

Salary Range

At Blue Cross NC we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training specialized skill sets licensure and certifications and other business and organizational base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus* 401(k) with employer match Paid Time Off (PTO) and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$89174.00 - $142679.00

Skills

Application Implementation Best Practices Development Business Process Improvements Business Requirements Business Requirements Analysis Information Technology (IT) Projects Information Technology Project Management Requirements Gathering Requirements Management Technical Architecture

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