Remote Lead Analyst: Digital HEDIS & Quality Analytics

EmblemHealth; New York, Northern (NY, KY); Hybrid; USD 78,000 - 149,000; Full time

Job summary

EmblemHealth seeks a Lead Analyst for Digital HEDIS & Quality Analytics to drive the digital strategy within the quality measurement analytics team. You will lead automation of reporting, manage data governance, and support QA for HEDIS/QARR/Star metrics across available data sources.

You will prepare dashboards, perform advanced analyses, and collaborate with IT, vendors, and auditors to ensure digital readiness, including FHIR readiness.

Qualifications

• Bachelor’s or higher in analytical/quantitative field; Master’s 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 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, or others) (Required).
• Experience with data visualization tools (Power BI, Tableau) (Required).
• Demonstrated self-starter with ability to develop projects end to end independently (Required).

Responsibilities

• 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.

Skills

HEDIS / Medicare Stars

Power BI

Tableau

Python

R

SAS

SQL

MS Office

Data governance

Self-starter

Education

Bachelor’s Degree in analytical/quantitative field

Master’s Degree preferred

Tools

SAS

R

SQL

Job description

EmblemHealth seeks a Lead Analyst for Digital HEDIS & Quality Analytics to drive the digital strategy within the quality measurement analytics team. You will lead automation of reporting, manage data governance, and support QA for HEDIS/QARR/Star metrics across available data sources.

You will prepare dashboards, perform advanced analyses, and collaborate with IT, vendors, and auditors to ensure digital readiness, including FHIR readiness.