HEDIS Data Analyst / Business Analyst

Jobtailor; Deutschland; Vor Ort; EUR 55.000 - 85.000; Vollzeit

Zusammenfassung

Jobtailor in Germany is seeking a Healthcare Data Analyst to support HEDIS measurement, reporting, validation, and annual submission activities within a payer environment.

You will translate business requirements into data and reporting solutions, analyze performance results, and collaborate with quality, population health, and care management teams to close care gaps.

Qualifikationen

• Bachelor's degree in Healthcare Administration, Information Systems, Public Health or related field.
• 4–6+ years of healthcare payer or managed care experience.
• Strong hands-on HEDIS knowledge and experience supporting HEDIS reporting initiatives.
• Experience in CMS regulations, STAR Ratings, and regulatory reporting.
• Experience analyzing healthcare data including claims, encounters, and eligibility.

Aufgaben

• Support HEDIS measurement, reporting, validation, and annual submission activities.
• Interpret HEDIS measure specifications and translate requirements into data solutions.
• Analyze HEDIS performance results and identify opportunities to improve quality scores.
• Partner with quality, population health, and care management teams to support HEDIS.
• Assist with audits, documentation reviews, and quality assurance activities.
• Gather, analyze, document, and validate business requirements from stakeholders.
• Perform root cause analysis on data quality issues impacting HEDIS and CMS reporting.
• Develop source-to-target mappings, business rules, and process flows.
• Analyze large healthcare datasets and present findings to business stakeholders.
• Support UAT testing, reconciliation, defect resolution, and deployment validation.
• Analyze claims, encounters, eligibility, provider, and pharmacy data used for CMS reporting.
• Validate data completeness, accuracy, reconciliations, and reporting outputs.
• Support CMS quality initiatives, STAR Ratings programs, and regulatory reporting.
• Collaborate with teams to improve reporting processes and data governance.
• Understand payer workflows including claims, provider data, enrollment, and quality programs.
• Solve complex payer data challenges with consultants and client stakeholders.
• Facilitate requirements sessions, stakeholder interviews, and process reviews.
• Translate technical findings into business recommendations and executive communications.
• Support strategic payer transformation and data modernization initiatives.

Kenntnisse

HEDIS knowledge

SQL

Communication skills

Business analysis

Stakeholder management

Ausbildung

Bachelor's degree in Healthcare Administration

Tools

Healthcare data analysis tools

Jobbeschreibung

Responsibilities

• Support HEDIS measurement, reporting, validation, and annual submission activities.
• Interpret HEDIS measure specifications and translate business requirements into data and reporting solutions.
• Analyze HEDIS performance results and identify opportunities to improve quality scores and close care gaps.
• Partner with quality, population health, provider engagement, and care management teams to support HEDIS initiatives.
• Assist with HEDIS audits, documentation reviews, and quality assurance activities.
• Gather, analyze, document, and validate business requirements from health plan stakeholders.
• Perform root cause analysis on data quality issues impacting HEDIS, CMS reporting, and operational performance.
• Develop source-to-target mappings, business rules, process flows, and functional specifications.
• Analyze large healthcare datasets and present findings, trends, and recommendations to business stakeholders.
• Support UAT testing, reconciliation, defect resolution, and deployment validation activities.
• Analyze claims, encounters, eligibility, provider, pharmacy, and supplemental data used for HEDIS and CMS reporting.
• Validate data completeness, accuracy, reconciliation results, and reporting outputs.
• Support CMS quality initiatives, STAR Ratings programs, and regulatory reporting requirements.
• Collaborate with business and technical teams to improve reporting processes and data governance practices.
• Understand payer operational workflows including claims processing, provider data, membership, enrollment, and quality management programs.
• Work directly with Huron consultants and client stakeholders to solve complex payer data challenges.
• Facilitate requirements sessions, stakeholder interviews, and process reviews.
• Translate technical findings into business recommendations and executive-level communications.
• Support delivery of strategic payer transformation and data modernization initiatives.

Requirements

• Bachelor's degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or related field
• 4–6+ years of healthcare payer, health plan, or managed care experience.
• Strong hands‑on HEDIS knowledge and experience supporting HEDIS reporting initiatives.
• Experience working within a Health Plan, Managed Care Organization, Medicare Advantage, Medicaid, or Commercial payer environment.
• Understanding of CMS regulations, CMS STAR Ratings, quality programs, and regulatory reporting requirements.
• Experience analyzing healthcare data including: Claims Encounters Membership/Eligibility Provider Data Pharmacy Data Supplemental Clinical Data
• Strong business analysis skills including requirements gathering, process documentation, and stakeholder management.
• Advanced SQL experience for healthcare data analysis and validation.
• Experience performing data quality reviews, reconciliations, and root cause analysis.
• Strong communication and presentation skills.