Role: HEDIS Data Analyst
Location: Newark, NJ or nearby (remote, 2–4 days/month onsite)
Key Responsibilities:
- HEDIS Analytics → Develop/validate HEDIS measures per NCQA specs, analyze claims/eligibility/EHR/pharmacy/lab data, support annual submissions, audits, and dashboards.
- Data Engineering → Build/optimize SQL queries, ETL pipelines, and data transformations; improve data quality; document lineage and mappings.
- Chart Review → Manage provider lists, validate chart abstraction, support outreach for care gaps.
- Collaboration → Work with Quality, Clinical, Provider Relations, and Compliance teams; provide guidance on anomalies; present insights to leadership.
- Audit & Compliance → Assist with NCQA audit prep, ensure regulatory adherence, maintain audit trails and reporting artifacts.
Technical Skills:
- Advanced SQL (required)
- Experience with healthcare payer datasets (claims, eligibility, provider, EMR, pharmacy, lab)
- Knowledge of coding standards (ICD‑10, CPT, HCPCS, LOINC, NDC)
Domain Knowledge:
- Deep understanding of NCQA HEDIS specs
- Experience with hybrid & administrative measures
- Familiarity with audit processes, care gap workflows, and CMS Star Ratings
Regards,
Manoj Goud
Derex Technologies INC
Contact : 973-834-5005 Ext 206
Derex Technologies Inc specializes in providing IT consulting, staffing solutions and software services. Globally headquartered in Harrison New Jersey since 1996 Derex delivers the highest quality technology professionals and an array of customized IT talent solutions designed to improve productivity and drive results to global clients throughout North America.
With over two decades of unparalleled experience, Derex provides supports to its clientele, across such industries as Systems Integration, Banking and Finance, Telecommunications, Pharmaceutical and Life Sciences, Energy, Healthcare, Technology, Transportation, and local and federal Government agencies.
All your information will be kept confidential according to EEO guidelines.