HEDIS Data Analytics Consultant

HEDIS Data Analytics Consultant

Position Type: Contract, with Right-to-Hire Opportunity
Location: Remote

Position Summary

The HEDIS Data Analytics Consultant designs, develops, and supports healthcare data analytics, integration, and reporting solutions that enable accurate and timely HEDIS reporting. This role partners with Clinical Quality, Population Health, IT, EHR vendors, data aggregators, and HEDIS software vendors to manage large healthcare datasets, automate data ingestion and validation, support Medical Record Review (MRR) activities, and ensure compliance with annual NCQA HEDIS requirements.

Primary Responsibilities

• Develop, optimize, and maintain HEDIS reporting solutions, complex SQL queries, and automated data workflows using SQL, Python, Alteryx, AWS, and Microsoft Office.

• Interpret annual NCQA HEDIS technical specification changes and assess their impact on data, reporting, and production processes.

• Support annual HEDIS production and Medical Record Review (MRR) activities, including chart retrieval, supplemental data validation, reconciliation, and issue resolution.

• Provide ongoing analytics and reporting support to Clinical Quality teams between HEDIS seasons, including measure monitoring and quality improvement initiatives.

• Manage large volumes of inbound and outbound healthcare data files from internal systems, EHR vendors, data aggregators, and HEDIS software vendors.

• Validate claims, enrollment, provider, pharmacy, supplemental, EHR, and clinical data in accordance with NCQA HEDIS specifications.

• Develop and maintain automated data ingestion, transformation, validation, and quality assurance processes.

• Investigate data quality, ingestion, and integration issues; perform root cause analysis of HEDIS rate variances; and coordinate corrective actions with IT, vendors, and business stakeholders.

• Collaborate with EHR vendors, data aggregators, and HEDIS software vendors to resolve data issues and support annual HEDIS production.

• Participate in user acceptance testing (UAT), production support, and NCQA audit readiness activities.

• Create and maintain technical documentation, data mappings, validation procedures, and process documentation.

Required Qualifications

• Bachelor's degree in Computer Science, Information Systems, Health Informatics, Data Analytics, or a related field.

• 5+ years of experience in healthcare data analytics.

• 3+ years of hands-on HEDIS reporting experience.

• Advanced SQL development experience, including complex joins, CTEs, window functions, and query optimization.

• Proficiency with Python, Alteryx, AWS, and Microsoft Office.

• Experience working with large-scale healthcare datasets containing millions of records.

• Experience working with healthcare claims, enrollment, provider, pharmacy, EHR, supplemental, and clinical data.

• Experience supporting data integration and collaborating with EHR vendors, data aggregators, and/or HEDIS software vendors.

• Strong analytical, problem-solving, communication, and technical documentation skills.

Preferred Qualifications

• Experience supporting HEDIS programs across Medicare, Medicaid, Commercial, and Marketplace populations.

• Experience supporting annual HEDIS production and Medical Record Review (MRR) operations.

• Experience with healthcare interoperability standards, including FHIR, HL7, C-CDA/CCD, and REST APIs.

• Experience with AWS cloud-based data and analytics environments.

• Experience supporting NCQA HEDIS Compliance Audit activities.