HEDIS Data Analyst / Business Analyst

Huron is a global consultancy that helps healthcare organizations drive growth and enhance performance. They are seeking a HEDIS Data Analyst / Business Analyst to support HEDIS measurement, reporting, and validation activities while collaborating with various teams to improve quality scores and operational performance.

Responsibilities:

• Support HEDIS measurement, reporting, validation, and annual submission activities
• Interpret HEDIS measure specifications and translate business requirements into data and reporting solutions
• Analyze HEDIS performance results and identify opportunities to improve quality scores and close care gaps
• Partner with quality, population health, provider engagement, and care management teams to support HEDIS initiatives
• Assist with HEDIS audits, documentation reviews, and quality assurance activities
• Gather, analyze, document, and validate business requirements from health plan stakeholders
• Perform root cause analysis on data quality issues impacting HEDIS, CMS reporting, and operational performance
• Develop source-to-target mappings, business rules, process flows, and functional specifications
• Analyze large healthcare datasets and present findings, trends, and recommendations to business stakeholders
• Support UAT testing, reconciliation, defect resolution, and deployment validation activities
• Analyze claims, encounters, eligibility, provider, pharmacy, and supplemental data used for HEDIS and CMS reporting
• Validate data completeness, accuracy, reconciliation results, and reporting outputs
• Support CMS quality initiatives, STAR Ratings programs, and regulatory reporting requirements
• Collaborate with business and technical teams to improve reporting processes and data governance practices
• Understand payer operational workflows including claims processing, provider data, membership, enrollment, and quality management programs. Work directly with Huron consultants and client stakeholders to solve complex payer data challenges
• Facilitate requirements sessions, stakeholder interviews, and process reviews
• Translate technical findings into business recommendations and executive-level communications
• Support delivery of strategic payer transformation and data modernization initiatives

Requirements:

• Bachelor's degree in Healthcare Administration, Information Systems, Business, Data Analytics, Public Health, or related field. Additional relevant work experience in lieu of degree may be considered
• 4–6+ years of healthcare payer, health plan, or managed care experience
• Strong hands-on HEDIS knowledge and experience supporting HEDIS reporting initiatives
• Experience working within a Health Plan, Managed Care Organization, Medicare Advantage, Medicaid, or Commercial payer environment
• Understanding of CMS regulations, CMS STAR Ratings, quality programs, and regulatory reporting requirements
• Experience analyzing healthcare data including: Claims, Encounters, Membership/Eligibility, Provider Data, Pharmacy Data, Supplemental Clinical Data
• Strong business analysis skills including requirements gathering, process documentation, and stakeholder management
• Advanced SQL experience for healthcare data analysis and validation
• Experience performing data quality reviews, reconciliations, and root cause analysis
• Strong communication and presentation skills