Job Description

Role: HEDIS Operations Manager / Analyst.

Location: Remote.

Duration: Long Term Contract.

Key Responsibilities:

• Support accurate HEDIS data collection, abstraction, and reporting.
• Interpret and apply NCQA HEDIS technical specifications and measurement requirements.
• Monitor, track, analyze, and report HEDIS performance metrics.
• Develop, maintain, and improve operational workflows and processes.
• Manage data quality, validate measure logic, and prepare metrics for reporting and audits.
• Coordinate end-to-end HEDIS processes, including chart chase/abstraction and vendor management.
• Partner with clinical and operational teams, vendors, and systems to ensure data integrity and completeness.
• Track performance trends and identify opportunities for compliance improvement measures.
• Support HEDIS audit activities end-to-end including proper documentation and artifacts.

Skills Often Required:

• Strong data interpretation and analytic skills.
• Workflow/process development.
• NCQA/HEDIS specifications knowledge.
• Cross-functional communication.
• Strong SQL skills with Power BI and SSRS (Paginated Report) experience.
• Knowledge of different file formats (Standard and Non-Standard) such as EDI, HL7 and custom files.

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