HEDIS Analyst

Kforce Inc; Fairfield (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

Kforce Inc. is assisting a client in Fairfield, CA, to hire a HEDIS Analyst for year-round auditing and program management. The role emphasizes data analysis, reporting, and cross-department collaboration to improve health plan quality measures.

The ideal candidate will have HEDIS experience, strong Excel/SQL skills, and the ability to drive data-driven decisions. This is a full-time position based in California with comprehensive benefits.

Qualifications

• Clear communication skills.
• Ability to implement performance strategies for the team.
• Stakeholder engagement - e.g., provider webinars.
• Critical thinking.
• Strong organizational skills.
• Ability to prioritize assignments.
• HEDIS experience preferred, especially HEDIS audit experience.
• Audit deliverables documents (the roadmap).
• SQL and Excel proficiency are desirable.

Responsibilities

• Prepare, analyze, report, and manage data for plan-wide and regional decision making on key quality measures.
• Collaborate with departments to identify data needs, develop queries, and support reporting.
• Develops and maintains data management and analytics program knowledge.
• May manage data integration and lead system-level user testing.
• Use Enterprise Data Warehouse and other sources to identify data for analysis.
• Validate reports and ensure data completeness and accuracy.
• Define business requirements with stakeholders and identify data needs.
• Develop data collection plans to measure baseline performance and interventions.

Skills

Clear communication

Stakeholder engagement

Critical thinking

Strong organizational skills

Ability to prioritize assignments

Ability to implement performance

HEDIS experience

Tools

SQL

Advanced Excel

Job description

Responsibilities

Kforce's client in Fairfield, CA is looking for a HEDIS Analyst. The HEDIS team needs additional support for year-round auditing and program management. Responsibilities:

• Prepare, analyze, report, and manage data used for both plan-wide and regional decision making for evaluating performance in key quality measures and the effective use of health plan resources on a routine and ad hoc basis
• Works collaboratively with departments company-wide to identify data needs, develop and maintain data queries and tools, and complete accurate reporting to support performance and process improvements
• Develops and maintains working knowledge (technical and user interfaces) of data management and analytics programs and systems
• May manage/monitor data integration into data infrastructure and may lead system-level user testing
• Utilizes the Enterprise Data Warehouse and other data sources to identify and isolate data for analysis
• Validates data reports and manages key data sources within program requirements, to ensure the completeness and accuracy of data
• Works collaboratively with various departments (i.e. QI, IT, Finance, and Analytics teams) and external stakeholders to define business requirements and identify data needs
• Develops and executes data collection plans that identify baseline performance and capture the impact of interventions
• Analyzes performance data (which may include data trending or stratification) to identify areas for improvement
• Provides actionable recommendations and informs stakeholders of the impact of key decisions based on available data
• Provides project management support for data related and performance/process improvement projects, which may include HEDIS, PDQ, pay-for-performance programs, and others as assigned
• Tracks multiple deliverables and collaborates closely with broader project team

Requirements

• Clear communication skills
• Ability to implement performance strategies for the team
• Stakeholder engagement - e.g., provider webinars
• Critical thinking
• Strong organizational skills
• Ability to prioritize assignments

HEDIS experience preferred, especially:

• HEDIS audit experience
• Audit deliverables documents (the roadmap)
• Ability to implement performance strategies for the team
• Stakeholder engagement - e.g., provider webinars

Tools

• Advanced Excel
• SQL is a huge plus - build queries and reports

Nice To Have

• SQL
• DNSP or Medicare

The pay range is the lowest to highest compensation we reasonably in good faith believe we would pay at posting for this role. We may ultimately pay more or less than this range. Employee pay is based on factors like relevant education, qualifications, certifications, experience, skills, seniority, location, performance, union contract and business needs. This range may be modified in the future.

We offer comprehensive benefits including medical/dental/vision insurance, HSA, FSA, 401(k), and life, disability & ADD insurance to eligible employees. Salaried personnel receive paid time off. Hourly employees are not eligible for paid time off unless required by law. Hourly employees on a Service Contract Act project are eligible for paid sick leave.

Note: Pay is not considered compensation until it is earned, vested and determinable. The amount and availability of any compensation remains in Kforce's sole discretion unless and until paid and may be modified in its discretion consistent with the law.

This job is not eligible for bonuses, incentives or commissions.

Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.