HEDIS Data Analyst
Location
New Jersey
Posted
20 hours ago
Salary
0
Seniority
Senior
Job Description
HEDIS Data Analyst
Derex Technologies Inc
• Develop/validate HEDIS measures per NCQA specs, analyze claims/eligibility/EHR/pharmacy/lab data, support annual submissions, audits, and dashboards. • Build/optimize SQL queries, ETL pipelines, and data transformations; improve data quality; document lineage and mappings. • Manage provider lists, validate chart abstraction, support outreach for care gaps. • Work with Quality, Clinical, Provider Relations, and Compliance teams; provide guidance on anomalies; present insights to leadership. • Assist with NCQA audit prep, ensure regulatory adherence, maintain audit trails and reporting artifacts.
Job Requirements
- Advanced SQL (required)
- Experience with healthcare payer datasets (claims, eligibility, provider, EMR, pharmacy, lab)
- Knowledge of coding standards (ICD‑10, CPT, HCPCS, LOINC, NDC)
- Deep understanding of NCQA HEDIS specs
- Experience with hybrid & administrative measures
- Familiarity with audit processes, care gap workflows, and CMS Star Ratings
Benefits
- All your information will be kept confidential according to EEO guidelines.
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