Senior Data Analyst, HEDIS - Denver Health Medical Plan (Must Be A Colorado Resident)

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Department

*Must Be A Colorado Resident

Job Summary

The Senior HEDIS Data Analyst is responsible for the comprehensive analysis, validation, and reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures for Denver Health Medical Plan. This position plays a key role in driving performance improvement through rigorous data analytics, identification of trends and opportunities, and the development of actionable insights. The Senior Analyst collaborates with clinical, operational, and technical teams as well as vendors and auditors to ensure accurate and timely reporting, regulatory compliance, and strategic execution of HEDIS initiatives across all product lines.

Essential Functions:

• Lead end-to-end HEDIS project data support, including data extraction, transformation, validation, and submission in accordance with NCQA technical specifications and regulatory timelines. (0%)
• Analyze HEDIS measure performance across Medicare, Medicaid, Exchange and Commercial lines of business; identify performance trends and root causes of underperformance. (0%)
• Present findings and recommended actions to leadership and stakeholder teams (10%)
• Partner with internal stakeholders, such as Quality Improvement, Population Health, Clinical Operations, HEDIS Team and IT, to support interventions aimed at improving HEDIS outcomes and identifying additional sources to obtain data. (10%)
• Design and develop dashboards and reports that provide actionable insights to both technical and non-technical audiences. (10%)
• Develop methods and workflows to improve data mapping and accuracy, generation of performance reports, identification of gaps in care, and methods to identify new data sources, including processes to assist in the transition to FHIR (Fast Healthcare Interoperability Resources) standards. (10%)
• Serve as primary data liaison external vendors and auditors to ensure completeness and accuracy of medical record review and supplemental data integration to support HSAG, HCPF, CMS, NCQA submissions. (10%)
• Responsible for timely submission of the Annual NCQA HEDIS ROADMAP, HEDIS Audit, IDSS and related data submissions including the closure of Issue Log items and performing benchmarking of collected data. (10%)
• Serves as subject matter expert on HEDIS data methodologies, including Hybrid, Administrative and Electronic Clinical Data Systems (ECDS) collection methods. (10%)
• Work with Denver Health and Hospital Authority to optimize data in structured data fields in Epic EHR to support ECDS (10%)
• Validate source system data and perform quality assurance checks to ensure data integrity for HEDIS and other quality reporting programs. (10%)
• Stay current on NCQA guidelines, CMS and state-specific requirements, and industry best practices. (5%)
• Support the development of standardized analytics tools and processes. (5%)

Education:

• Bachelor's Degree public health, Health Informatics, Statistics, Computer Science, or a related field required
• Master's degree preferred

Work Experience:

• 4-6 years experience in health care data analytics, with at least 3 years focused specifically on HEDIS or quality measurement reporting in a health plan or similar environment required

Licenses:

Knowledge, Skills and Abilities:

• Strong knowledge of NCQA HEDIS specifications, CMS Star Ratings, and regulatory reporting to State and Federal programs.
• In-depth knowledge of HEDIS lifecycle, including NCQA IDSS tool usage.
• Familiarity with data from clinical systems (e.g., EMR/EHR), claims, encounters, and supplemental data sources.
• Excellent problem-solving, communication, multi-disciplinary collaboration and project management skills.
• Proficiency in Microsoft Office (Excel, PowerPoint, Word).
• Accuracy and attention to detail in data analysis and reporting.
• Proven ability to meet deadlines and manage deliverables.
• Ability to work independently and manage multiple competing priorities in a fast-paced environment.
• Experience with HEDIS software tools (e.g., Inovalon QSI-XL, Cotiviti, OnPoint, or other vendors), preferred
• Experience working with Medicaid, Exchange, Medicare Advantage, or Dual Eligible populations, preferred
• Knowledge of risk adjustment, care gaps, or other quality-related initiatives such as CAHPS or Health Outcomes Survey (HOS), preferred
• Advanced proficiency with SQL (Oracle, SQL Server, or similar), with experience writing complex queries and optimizing data pipelines, preferred
• Experience using reporting and data visualization tools (e.g., Tableau, Power BI, SAS, R, Python), preferred
• CPHQ (Certified Professional in Healthcare Quality) certification, preferred

Shift

Work Type

Salary

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community.

Applicants will be considered until the position is filled.