HEDIS Architect / Data Analyst

Healthcare IS; United States; On-site; USD 110,000 - 150,000; Full time

Job summary

Healthcare IS is seeking an experienced HEDIS Architect / Data Analyst to support HEDIS measurement, CMS STARs, and regulatory reporting. The role bridges business stakeholders, quality teams, and technical partners to deliver accurate insights and scalable data solutions.

The ideal candidate has 4–6+ years in a health plan environment, strong SQL skills, and hands-on HEDIS expertise to drive data modernization and quality improvements.

Qualifications

• Bachelor's degree or equivalent in a relevant field.
• 4–6+ years in healthcare payer, health plan, or managed care.
• Hands-on HEDIS knowledge and experience supporting HEDIS reporting initiatives.
• Exposure to data architecture concepts and data platform modernization.
• Advanced SQL for healthcare data analysis and validation.

Responsibilities

• Support HEDIS measurement, reporting, validation, and annual submission activities.
• Translate business requirements into data and reporting solutions.
• Analyze HEDIS performance to identify improvement opportunities and close care gaps.
• Contribute to HEDIS solution architecture, data flow design, and scalable data models.
• Collaborate with architects, engineering, quality, and operations to align reporting with platform capabilities.
• Facilitate requirements sessions and translate findings into executive communications.

Skills

HEDIS knowledge

SQL

Data analysis

Business analysis

Stakeholder management

Data quality & reconciliation

Requirements gathering

Education

Bachelor's degree

Job description

We are seeking a HEDIS Architect / Data Analyst with 4–6+ years of healthcare payer experience and strong expertise in HEDIS reporting, CMS quality programs, healthcare claims data, payer operations, and the ability to contribute to solution architecture discussions for HEDIS reporting and payer data modernization initiatives.

The ideal candidate will possess hands‑on experience working within a health plan or healthcare payer environment and demonstrate the ability to analyze, validate, and transform healthcare data into actionable insights that support HEDIS, CMS STARs, quality improvement, and regulatory reporting initiatives. This role serves as a bridge between business stakeholders, quality teams, operational leaders, and technical teams to ensure accurate and compliant reporting while contributing to scalable solution design, data architecture, and measurable performance improvements.

Primary 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.
• Contribute to HEDIS solution architecture activities, including data flow design, integration approach, reporting architecture, and scalable data model recommendations.
• Partner with technical architects and engineering teams to align HEDIS reporting requirements with platform capabilities, data governance standards, and long‑term architecture decisions.
• 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.

Required Qualifications

• Bachelor's degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or related field. Additional relevant work experience in lieu of degree may be considered.
• 4–6+ years of healthcare payer, health plan, or managed care experience.
• Experience supporting solution design, architecture documentation, technical requirements, or data platform modernization efforts for HEDIS, quality reporting, or payer analytics solutions.
• Exposure to healthcare data architecture concepts, including source‑to‑target mapping, data lineage, integration design, reporting architecture, and scalable data model design.
• 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
• 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.