Health Data Analyst II

Position Summary Fast growing Medicare Advantage health maintenance organization is looking to add a strong and dynamic Health Data Analyst II. The Health Data Analyst II supports quality improvement, regulatory compliance, and performance optimization initiatives across Medicare Advantage programs. This position focuses on data collection, basic and complex analytics such as predictive modeling, quality reporting, and cross-functional collaboration to contribute to improved outcomes in Star Ratings, HEDIS measures, and Risk Adjustment programs Essential Duties and Responsibilities Data Analytics & Quality Reporting • Lead Medicare Advantage Star Ratings initiatives by performing data analysis, performance monitoring, and gap-to-goal reporting across Part C and Part D measures (e.g., medication adherence, preventive screenings, chronic condition management, member experience surveys) • Manage with Risk Adjustment programs by supporting medical record retrieval tracking, data validation, and preparation of reports for retrospective and prospective reviews and CMS RADV audit readiness • Extract and analyze complex data from EHR, claims, encounter, and pharmacy systems to assess performance on quality, Stars, and risk adjustment metrics; identify trends, root causes and opportunities for improvement • Create dashboards, reports, and presentations that translate data findings into clear, actionable insights for stakeholders • Coordinate and track HEDIS roadmap submissions, ensuring timely completion and accuracy of required reporting _ Regulatory Compliance & CMS Monitoring_ • Maintain expert-level working knowledge of CMS, NCQA, and Stars memos and regulatory updates; maintain organized documentation of changes • Track CMS guidance documents and regulatory changes; summarize and communicate relevant updates to team members and stakeholders • Draft relevant comments based on CMS proposed rules and policy changes as directed • Support organizational compliance efforts by generating required reports • Research, compile, and distribute regulatory, operational, and ad-hoc reports based on project and leadership priorities EHR & Provider Relations Support • Serve as a subject matter expert and primary liaison for EHR-based quality and risk adjustment initiatives • Collaborate with provider relations team and IT team to support EHR data extraction, validation, mapping, and submission for quality and risk adjustment programs • Drive implementation and optimization of EHR workflows for structured data capture, and quality measure reporting • Identify and document data quality issues related to EHR feeds, clinical documentation, and interoperability that impact Stars, HEDIS, and Risk Adjustment performance; escalate issues as appropriate Required Qualifications: • Bachelor's degree in Health Information Management, Public Health, Data Analytics, Healthcare Administration, or related field with at least 5-7 years of experience or Master’s degree in analytical discipline with at least Three (3) year of health analytics experience related to Medicare, Stars or HEDIS preferred. • Proven experience to CMS Stars, HEDIS measures, or Risk Adjustment concepts through prior work experience • Strong understanding of CMS regulatory frameworks and compliance requirements • Advanced analytical and problem-solving skills, including predictive modeling, with exceptional attention to detail. • Proficiency in Microsoft Excel • Intermediate and advanced knowledge of SQL • Understanding of healthcare quality metrics and performance measurement • Excellent written and verbal communication skills • Ability to work collaboratively in a team environment and manage multiple tasks • Strong knowledge of healthcare claims and encounter data • Experience with data quality assessment or validation • Strong knowledge of data visualization tools (Power BI, Tableau, or similar) Preferred Qualifications: • Knowledge of EHR systems (Epic, Cerner, or similar) • Experience with Risk adjustment models Physical Requirements: • Please see Exhibit A Computer Skills: • Proficiency utilizing Microsoft Office to include Word, Excel, Access, power point. Affirmative Action/EEO statement: The Company provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Other duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Exhibit A Checklist: Job Analysis/Job Description Physical Activities Physical Activities Ascending or descending ladders, stairs, scaffolding, ramps, poles and the like. ☒ Never ☐ Occasionally ☐ Constantly Moving self in different positions to accomplish tasks in various environments including tight and confined spaces. ☒ Never ☐ Occasionally ☐ Constantly Remaining in a stationary position, often standing or sitting for prolonged periods.☐Never ☐Occasionally ☒ Constantly Moving about to accomplish tasks or moving from one worksite to another.☒ Never ☐ Occasionally ☐ Constantly Adjusting or moving objects up to 15 pounds in all directions.☐ Never ☒ Occasionally ☐ Constantly Communicating with others to exchange information.☐ Never ☐ Occasionally ☒ Constantly Repeating motions that may include the wrists, hands and/or fingers.☐ Never ☐ Occasionally ☒ Constantly Operating machinery and/or power tools.☒ Never ☐ Occasionally ☐ Constantly Operating motor vehicles or heavy equipment.☒ Never ☐ Occasionally ☐ Constantly Assessing the accuracy, neatness and thoroughness of the work assigned.☐ Never ☐ Occasionally ☒ Constantly Environmental Conditions Low temperatures.☒ Never ☐ Occasionally ☐ Constantly High temperatures.☒ Never ☐ Occasionally ☐ Constantly Outdoor elements such as precipitation and wind.☒ Never ☐ Occasionally ☐ Constantly Noisy environments.☐ Never ☒ Occasionally ☐ Constantly Hazardous conditions.☒ Never ☐ Occasionally ☐ Constantly Poor ventilation. ☒ Never ☐ Occasionally ☐ Constantly Small and/or enclosed spaces.☒ Never ☐ Occasionally ☐ Constantly No adverse environmental conditions expected. ☒ Never ☐ Occasionally ☐ Constantly Physical Demands Sedentary work that primarily involves sitting/standing. ☐ Never ☐ Occasionally ☒ Constantly Light work that includes moving objects up to 20 pounds. ☐ Never ☒ Occasionally ☐ Constantly Medium work that includes moving objects up to 50 pounds. ☒ Never ☐ Occasionally ☐ Constantly Heavy work that includes moving objects up to 100 pounds or more. ☒ Never ☐ Occasionally ☐ Constantly Pay: $82,000.00 - $95,000.00 per year Benefits: • 401(k) • 401(k) matching • Dental insurance • Disability insurance • Employee assistance program • Flexible spending account • Health insurance • Health savings account • Life insurance • Paid time off • Vision insurance Work Location: Remote Apply tot his job Apply To this Job