HEDIS Analyst

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Job Overview

The Data Analyst – HEDIS Reporting is responsible for managing, analyzing, and interpreting healthcare data to support HEDIS reporting and quality improvement initiatives. This role will collaborate with cross-functional teams, such as Quality, IS, Medical Record Operations, and Regulatory to ensure accurate, timely, and complete HEDIS submissions and to identify opportunities to improve healthcare outcomes and performance metrics.

Work Arrangement

• Monday through Friday, 8:30 AM EST to 5:00 PM EST

• Remote role

Responsibilities

• Lead HEDIS lifecycle validation and submission process.

• Develop, maintain, and automate HEDIS measure reporting using SQL, Python, Data Bricks, or other analytical tools.

• Analyze medical, pharmacy, and enrollment data as needed to validate HEDIS results.

• Collaborate with internal and external customers to ensure data accuracy and completeness.

• Support supplemental data integration and hybrid review process.

• Perform root cause analysis on data quality issues and recommend process improvements.

• Design dashboards and reports to track and trend HEDIS performance using Tableau and/or Power BI.

• Provide analytical support for interventions aimed at improving HEDIS and STAR ratings performance.

• Create visualizations and presentations to communicate findings to leadership and stakeholders.

• Mentor analysts and provide technical and analytic guidance.

• Lead and contribute data-driven projects that enhance quality reporting capabilities.

• Stay current on NCQA specifications, CMS guidance, and healthcare analytics best practices.

Education and Experience

• Bachelor’s degree in data science, data analytics, or technology related field is preferred.

• 5+ years of experience in healthcare data analytics, with at least 2 years focused on HEDIS or quality measurement reporting is required.

• Experience with NCQA-certified HEDIS software is preferred.

• Experience with HEDIS data submissions is preferred.

• Proficiency in SQL and or more analytics tools (Data Bricks, Python) is required.

• Strong understanding of healthcare data structures (claims, eligibility, etc.).

• Familiarity with CMS STARs, CAHPS, HealthPlan Accreditation is preferred.

• Excellent problem solving, analytical, and critical thinking skills.

• Strong communication and presentation abilities-able to translate complex data into actionable insights.

• High attention to detail and ability to manage multiple priorities in a fast-paced environment.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.