Lead Analyst, Digital HEDIS & Quality Analytics - (Remote)

EmblemHealth; New York (NY); On-site; USD 77,000 - 149,000; Full time

Job summary

EmblemHealth is seeking a senior data analytics leader to drive the digital HEDIS strategy. You will optimize data governance, automate reporting, and build dashboards supporting HEDIS/QARR/Star metrics.

The role requires advanced analytics, vendor coordination, and cross-functional partnership to improve data quality and clinical insights. You will lead trend studies, develop automated workflows, and present actionable insights to stakeholders for strategic decisions.

Qualifications

• Bachelor’s Degree in analytical/quantitative field incl. healthcare management, finance, business, statistics, engineering or related
• Master’s Degree preferred
• 5–8+ years of relevant, professional work experience
• 5+ years in managed care/healthcare analytics
• Advanced knowledge of HEDIS and Medicare Stars with electronic measures
• Proficient in Microsoft Office (Word, PowerPoint, Excel, Access)
• Advanced experience with relational databases (SAS, R, SQL)
• Experience with automation using Python, VBA, R, SAS or similar
• Experience with data visualization tools (Power BI, Tableau)
• Strong communication skills and ability to lead end-to-end projects

Responsibilities

• Lead implementation of digital HEDIS strategy and data governance
• Develop automated reporting and dashboards for quality metrics
• Perform data mining and reporting for stakeholders
• Collaborate with IT, vendors, providers to ensure digital readiness
• Conduct medical trend studies related to quality initiatives
• Develop complex statistical analyses for Medicare and Star measures
• Build self-service reports for the quality department
• Present findings to internal partners and drive decisions
• Improve data capabilities and data ingestion from multiple sources
• Support quality improvement initiatives with data-driven insights
• Oversee data intake, quality assurance, and measurement profiles

Skills

Healthcare analytics

HEDIS/Stars

SQL

R

SAS

Python

Data visualization

Power BI

Tableau

Excel

Communication

Education

Bachelor’s Degree

Master’s Degree preferred

Tools

SAS

R

SQL

Power BI

Tableau

Job description

Lead the implementation of the quality department digital HEDIS strategy under the quality measurement analytics team. Lead efforts to continually improve data capabilities and quality of department analysis and reporting. Develop and implement automation of manual reporting and analysis of business implications and trends. Develop, automate, and manage the intake, use and data governance of clinical and supplemental data sources to support all HEDIS/QARR/Star metrics. Identify areas of opportunity and new data sources to support quality metrics. Work closely with quality department, IT, NCQA certified HEDIS vendor and auditors to ensure readiness for digital quality. Prepare and present analytical dashboards and data to key stakeholders to support strategic decision making.

Principal Accountabilities

• Develop, implement, and manage reporting and reconciliation workflows and document processes.
• Lead medical trend studies as they pertain to quality initiatives.
• Identify data improvement opportunities through review of HEDIS/QARR/Star reports and data outputs and detecting data acquisition, capture, and system error issues.
• Collaborate with IT and others to plan and execute digital readiness, including readiness for FHIR.
• Engage with vendors, providers, and others to identify new sources of clinical data ingestion (e.g. data aggregators, EHRs, HIEs, etc).
• Perform research and collection of data, including data mining and reporting, which is provided to various customers inside and outside the department.
• Lead the development of complex and/or advanced statistical/modeling analyses of quality metrics for Medicare, State Sponsored Programs, and other populations.
• Develop and maintain automated quality dashboards and measure profiles utilizing data visualization tools.
• Provide analytical and technical guidance for design, development and maintenance of quality improvement and wellness initiatives. Build self-service reports to be used by the quality department.
• Identify and analyze business problems related to quality experience of member, particularly related to how members receive care and other factors influencing the STARS rating.
• Present analytical findings to internal business partners, leading discussions and providing delivery of further analysis.
• Collaborate with internal quality management teams to assist on quality improvement initiatives.

Qualifications

• Bachelor’s Degree in analytical/quantitative field including healthcare management, finance, business, mathematics, engineering, applied stats/economics, or any other related fields
• Master’s Degree preferred
• 5 – 8+ years of relevant, professional work experience (Required)
• 5+ years of experience in managed care/healthcare analytics (Required)
• Advanced knowledge of HEDIS and Medicare Stars, including experience working with electronic clinical quality measures and related data sources (Required)
• Proficient in Microsoft Office (Word, PowerPoint, Excel, Access) (Required)
• Advanced experience with relational database applications (such as SAS, R, SQL, or others). (Required)
• Experience with improving and automating processes using programming languages/software (Python, VBA, R, SAS, C++, or others) (Required)
• Experience with and proficient in statistical software/programs (such as SAS, R, Stata, Minitab or others) (Preferred)
• Experience with and proficient in data visualization tools (such as Power BI, Tableau) (Required)
• Strong communication skills (verbal, written, presentation, interpersonal) (Required)
• Demonstrated self-starter with ability to develop projects end to end independently (Required)

Additional Information

• Requisition ID: 1000003328
• Hiring Range: $77,760-$149,040