Senior HEDIS Data Engineer & Validation Lead

Educology Solutions; Washington (District of Columbia); On-site; USD 110,000 - 170,000; Full time

Job summary

Educology Solutions is seeking a Senior HEDIS Data and Measurement Technical Consultant to support data feeds, transformations, and reporting for HEDIS measures. You will work with IT, data engineering, analytics, and vendors to ensure data accuracy and audit readiness.

The role emphasizes technical problem solving, data quality controls, and collaboration with cross-functional teams to maintain measure integrity and submission readiness.

Qualifications

• Seven or more years of experience in healthcare data, payer technology, healthcare analytics, or data engineering.
• At least three years of direct technical experience supporting HEDIS measurement or quality-reporting platforms.
• Strong knowledge of HEDIS data structures, measure processing, eligible populations, numerators, denominators, exclusions, and supplemental data.
• Experience working with claims, encounters, enrollment, provider, pharmacy, laboratory, clinical, and medical-record data.
• Demonstrated experience troubleshooting HEDIS measure discrepancies at the member and data-element level.
• Experience with SQL, relational databases, data profiling, ETL processes, and large healthcare datasets.
• Experience supporting HEDIS platform implementations, migrations, upgrades, or annual specification changes.

Responsibilities

• Analyze data from claims, encounters, enrollment, pharmacy, laboratory, provider, clinical, supplemental, and medical-record sources.
• Define and validate source-to-target mappings for HEDIS data feeds.
• Identify data gaps, duplicate records, missing values, coding discrepancies, and inconsistencies across source systems.
• Support the development and maintenance of ETL processes, data pipelines, file exchanges, APIs, and vendor interfaces.
• Establish and document data-source precedence and reconciliation rules in collaboration with HEDIS business owners.
• Troubleshoot failed, incomplete, delayed, or inaccurate data loads.
• Validate member eligibility, continuous enrollment, benefit coverage, provider attribution, event dates, and clinical data elements used in measure processing.
• Provide technical support for HEDIS measures, data repositories, abstraction tools, and reporting solutions.
• Analyze measure-calculation output and trace results back to source data and transformation logic.
• Investigate unexpected numerator, denominator, exclusion, compliance, and eligible-population results.
• Support measure configuration, system upgrades, annual HEDIS specification changes, and regression testing.

Skills

HEDIS data experience

SQL

ETL

data reconciliation

problem solving

communication

Tools

Cotiviti

Arcadia

Inovalon QSI-XL

QNXT

Azure

Databricks

Snowflake

Job description

Educology Solutions is seeking a Senior HEDIS Data and Measurement Technical Consultant to support data feeds, transformations, and reporting for HEDIS measures. You will work with IT, data engineering, analytics, and vendors to ensure data accuracy and audit readiness.

The role emphasizes technical problem solving, data quality controls, and collaboration with cross-functional teams to maintain measure integrity and submission readiness.