Healthcare Business Analyst

Key Responsibilities:

• Analyze and interpret Star Ratings and HEDIS metrics to identify performance gaps and improvement opportunities.
• Collaborate with clinical, operational, and IT teams to develop and implement strategies that enhance quality scores.
• Translate business needs into technical requirements, workflows, and reporting specifications.
• Develop dashboards and reports using tools like SQL, Power BI, Tableau, or similar platforms.
• Monitor regulatory updates from CMS, NCQA, and other governing bodies to ensure compliance.
• Support data validation, quality audits, and performance improvement initiatives.
• Document business processes and recommend enhancements to optimize outcomes.
• Assist in preparing presentations and reports for leadership and external stakeholders.

Qualifications:

• Bachelors degree in healthcare administration, Business, Information Systems, or related field.
• 3+ years of experience in healthcare analytics, quality improvement, or business analysis.
• Strong understanding of HEDIS measures, Medicare Star Ratings, and quality reporting frameworks.
• Proficiency in SQL, Excel, and data visualization tools.
• Excellent communication and stakeholder management skills.
• Experience with claims data, EHR systems, and risk adjustment models is a plus.

Preferred Skills:

• Familiarity with CAHPS, PQA, and other quality programs.
• Experience working with health plans, provider groups, or managed care organizations.
• Knowledge of data governance, ETL processes, and healthcare regulatory standards.