Data Analyst

OVERALL POSITION DESCRIPTION: Reporting to the Clinical Director, the Quality Data Analyst analyzes and reports healthcare quality data, including HEDIS and Medicare STARS, to support value-based care and regulatory compliance. This role monitors performance metrics, ensures data accuracy, supports Advanced Medical Home (AMH) requirements, and collaborates with clinical teams to improve patient outcomes. Strong healthcare analytics skills, clinical experience, and knowledge of NCQA and CMS standards are required.

This position requires the successful candidate to be located within North Carolina

ESSENTIAL FUNCTIONS:

• Quality Measure Reporting: Collect, validate, analyze, and report healthcare quality data based on standardized measures such as the Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare's STARS ratings program.
• Performance Monitoring & Improvement: Monitor Key Performance Indicators (KPIs) for value-based contracts, identifying gaps in care, utilization trends, and opportunities for quality improvement initiatives.
• Data Validation and Integrity: Ensure the accuracy and validity of both source data (medical, pharmacy, enrollment, claims) and reporting results to ensure compliance with regulatory standards and prepare for quality audits.
• Clinical Collaboration: Work closely with clinical teams, care managers, and providers to translate data insights into actionable improvements in patient care, such as closing care gaps or refining documentation practices.
• Advanced Medical Home (AMH) Support: Provide specific analytical support for AMH Tier 3 delegation requirements, including managing patient risk stratification data, tracking utilization in emergency departments and hospitals via ADT (Admission, Discharge, Transfer) feeds, and ensuring data sharing protocols are met with Prepaid Health Plans (PHPs).
• Dashboard Development: Design and maintain reports and interactive dashboards (using tools like Tableau or Power BI) to communicate performance measures and insights to stakeholders, management, and providers.
• Compliance: Formulate and ensure compliance with technical specifications, policies, and operating procedures set by regulatory bodies like the NCQA (National Committee for Quality Assurance) and CMS (Centers for Medicare & Medicaid Services).

EDUCATION AND EXPERIENCE:

• Bachelor’s degree in Health Informatics, Statistics, Public Health, or a related field required. Master’s degree in a related field preferred.
• RN/MA/LPN unrestricted license preferred.
• 3+ years of experience in a clinical environment required.
• Prior experience as a HEDIS analyst or in a similar role within a healthcare or managed care setting is preferred.
• Strong experience with data analysis tools, including SQL (essential for querying large healthcare datasets), Excel, and data visualization platforms like Tableau or Power BI.
• Knowledge of healthcare data types (claims, clinical, operational) and coding systems (ICD-10, CPT).
• Familiarity with HEDIS technical specifications, STARS measures, clinical quality measures (CQMs), and the specific requirements of the Advanced Medical Home (AMH) program.
• Strong analytical and problem-solving abilities to interpret complex data, perform root cause analysis on data quality issues, and drive evidence-based decisions.
• Exceptional communication, leadership, and problem-solving skills.
• Ability to travel up to 15%.

Application Question(s):

• How many years of clinical experience do you have (RN, LPN, MA, or similar)?
• How would you rate your proficiency in querying healthcare data sets?

1 - No Experience
2- Beginner
3- Intermediate
4- Advanced

• Have you used any of the following data visualization tools? If so, which ones?

- Tableau
- Power BI
- Qlik
- Excel dashboards

• Do you have experience analyzing claims, clinical, or any other forms of healthcare/non-healthcare data?
• Have you previously worked in a value-based care environment (e.g., ACO, Medicare Advantage, Medicaid AMH, shared savings programs)?
• Are you familiar with NCQA or CMS technical specifications for quality reporting?
• Do you have experience developing dashboards or reports for clinical teams or leadership?
• Will you now, or in the future, require sponsorship for employment visa status (e.g. H-1B visa status)?
• What are you looking for in terms of base salary?
• Are you located in North Carolina?

Education:

• Bachelor's (Required)

Location:

• Cary, NC 27513 (Required)

Work Location: In person