Medical Management Data Analyst

MetroPlusHealth; New York (NY); On-site; USD 90,000 - 120,000; Full time

Job summary

MetroPlusHealth in New York is seeking a Medical Management Data Analyst to support monthly HEDIS builds and annual quality reporting (HEDIS, QARR, PCMH) to NYS DOH and CMS. You will validate data feeds, run quality checks, and help maintain dashboards to track performance within a collaborative analytics team.

The role emphasizes data-driven improvements, needs strong SQL/SAS/Python/R skills, and a commitment to accurate, timely reporting in a fast-paced environment.

Qualifications

• Bachelor’s degree in information systems, data analytics, or a related field required.
• 3 years of experience extracting, manipulating, and analyzing data in a healthcare, public health, or analytics environment.
• 3 years of experience using analytics and BI tools (e.g., SQL, SAS, R, Python, Power BI, Tableau) to support data analysis and reporting.
• Ability to interpret and apply technical reporting specifications and measure logic using analytics tools to produce and validate quality reporting outputs.
• Demonstrated understanding of data quality concepts, with ability to execute data preparation, validation, and reconciliation processes with strong diagnostic rigor, including identifying data anomalies and discrepancies, applying validation rules, and ensuring accuracy of reporting outputs.
• Ability to collaborate with IT, data vendors, and internal stakeholders, with an understanding of data architecture, data flow, and dependencies across systems supporting quality reporting.

Responsibilities

• Support monthly HEDIS builds and annual HEDIS, QARR, and PCMH submissions, ensuring timely, accurate data for regulatory reporting.
• Monitor and prepare data inputs for monthly builds, including claims, provider, member, encounter, and supplemental data, ensuring completeness and proper delivery to vendor systems.
• Assist with intake, tracking, and ongoing support of data feeds from providers, vendors, and health information exchanges, contributing to stable data pipelines.
• Perform routine validation on HEDIS build outputs and quality measure results, including review of variances and discrepancies.
• Investigate and resolve data quality issues in collaboration with senior analysts and upstream data partners.
• Execute standard queries and data extracts to support monthly production processes, audits, and submission readiness activities.
• Handle routine and ad hoc data requests in support of quality improvement initiatives, including measure level data pulls, gap analysis, and performance tracking.
• Contribute to development, maintenance, and refinement of dashboards and reports used to monitor quality performance and pay for performance programs.
• Work with structured and unstructured data to support evolving data needs, including onboarding and validation of new data sources and pipelines.
• Support documentation, audit readiness, and continuous improvement of data workflows, ensuring consistency and transparency.

Skills

Data analysis

Data quality

Healthcare analytics

Data governance

SQL

SAS

R

Python

Power BI

Tableau

Education

Bachelor’s degree in information systems, data analytics, or related field

Master’s degree preferred

Tools

SQL

SAS

R

Python

Power BI

Tableau

Job description

Empower. Unite. Care. MetroPlus

Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.

Position Overview

The Medical Management Data Analyst supports Medical Management Analytics with a primary focus on monthly HEDIS builds and annual quality reporting submissions (HEDIS, QARR, PCMH) to NYS DOH and CMS, helping ensure data is accurate, complete, and delivered on time. In support of monthly HEDIS builds, the Analyst monitors and prepares key data inputs, including claims, provider, member, encounter, and supplemental data, ensuring these feeds are complete and properly delivered to downstream systems and vendor processes. The Analyst performs routine validation of build outputs, including measure-level quality checks, investigation of variances, and confirmation that results align with expected specifications and prior performance. This role also supports quality improvement efforts by handling routine and ad hoc data requests, including measure-specific analyses, and contributing to the development and maintenance of dashboards and reports used to track performance. The Analyst position requires comfort working with both structured and unstructured data and contributing to the setup and refinement of new data sources and pipelines that enhance quality reporting and analytics capabilities.

Work Shifts

9:00 AM - 5:00 PM

Duties & Responsibilities

• Support monthly HEDIS builds and annual HEDIS, QARR, and PCMH submissions, helping ensure timely, accurate, and complete data for rate production and regulatory reporting.
• Monitor and prepare key data inputs for monthly builds, including claims, provider, member, encounter, and supplemental data, ensuring completeness and proper delivery to vendor systems.
• Assist with intake, tracking, and ongoing support of data feeds from providers, vendors, and health information exchanges (HIEs/RHIO), contributing to stable and reliable data pipelines.
• Perform routine validation checks on HEDIS build outputs and quality measure results, including review of variances, identification of discrepancies, and confirmation against expected benchmarks.
• Investigate and resolve data quality issues in collaboration with senior analysts and upstream data partners to support accurate reporting.
• Execute standard queries and data extracts to support monthly production processes, audits, and submission readiness activities.
• Handle routine and ad hoc data requests in support of quality improvement initiatives, including measure level data pulls, gap analysis, and performance tracking.
• Contribute to the development, maintenance, and refinement of dashboards and reports used to monitor quality performance and pay for performance programs.
• Work with structured and unstructured data to support evolving data needs, including assisting with onboarding and validation of new data sources and pipelines.
• Support documentation, audit readiness, and continuous improvement of data workflows, ensuring consistency, transparency, and alignment with department analytics processes.

Minimum Qualifications

• Bachelor’s degree in information systems, data analytics, or a related field required. Master’s preferred.
• 3 years of experience extracting, manipulating, and analyzing data in a healthcare, public health, or analytics environment.
• 3 years of experience using analytics and BI tools (e.g., SQL, SAS, R, Python, Power BI, Tableau) to support data analysis and reporting.
• Ability to interpret and apply technical reporting specifications and measure logic using analytics tools to produce and validate quality reporting outputs.
• Demonstrated understanding of data quality concepts, with ability to execute data preparation, validation, and reconciliation processes with strong diagnostic rigor, including identifying data anomalies and discrepancies, applying validation rules, and ensuring accuracy of reporting outputs.
• Ability to collaborate with IT, data vendors, and internal stakeholders, with an understanding of data architecture, data flow, and dependencies across systems supporting quality reporting.

Professional Competencies

• Integrity & Trust
• Customer Focus
• Functional/Technical Skills
• Strong written and verbal presentation as well as data analysis skills required.
• Ability to work independently and multitask to meet deadlines.
• Position requires individual with high degree of accuracy. Must be able to translate theoretical knowledge into practical application.
• Displays strong communication, interpersonal, and leadership ability across all levels coupled with effective problem solving, conceptual thinking, quantitative and analytical skills.

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