Job Details

Job Description:
The Senior HEDIS Analyst, Technical Lead is responsible for end-to-end execution of HEDIS measurement, validation, and submission with a primary focus on HEDIS Engine (Cotiviti) production, rate validation, and NCQA IDSS submission for a designated health plan. This role ensures that HEDIS data is accurate, complete, traceable, and audit-ready through technical ownership of production runs, validation activities, and submission deliverables.

Responsibilities:

• Serve as the Technical Lead on the HEDIS production and submission lifecycle.
• Manage test, early production, and production run sequencing.
• Oversee ingestion of claims, encounters, enrollment, provider, and SDS (supplemental data sources) data.
• Ensure data integrity, traceability, and documentation of data flows within the HEDIS engine.
• Partner directly with HEDIS Engine (Cotiviti) staff to ensure issues are resolved timely.
• Translate business and clinical requirements into technical design with appropriate stakeholders.
• Support mapping, validation, PSV (primary source verification) preparation, and remediation activities.
• Troubleshoot SDS-related issues during runs and audit readiness activities.
• Own technical aspects of submissions, including Cotiviti output files, attest uploads, and NCQA IDSS technical files (XML and CSV).
• Support state submissions, as applicable.
• Ensure audit submissions are complete, timely, and compliant with applicable requirements.
• Provide technical evidence and analysis in response to audit requests.
• Perform root cause analysis for discrepancies or audit findings.
• Maintain technical documentation to support audit defense and continuity.
• Own technical QA and UAT activities, including measure output validation and variance analysis.
• Own technical QA and UAT activities for CAHPS sample generation and related technical files.
• Confirm technical outputs align with HEDIS specifications and business expectations.

Requirements:

• Bachelor’s degree in data analytics, information systems, or computer science
• 3+ years of experience in health care data analytics, with at least 3 years focused specifically on HEDIS technical experience in a health plan or similar environment
• 1+ years experience supporting data validation, QA and UAT, and/or audits
• 1+ years ability to communicate technical concepts to non-technical stakeholders and collaborate across departments
• 1+ years strong SQL and data analysis skills
• Strong knowledge of NCQA HEDIS specifications, CMS Star Ratings, and regulatory reporting to state and federal programs
• Hands-on experience running HEDIS cycles in Cotiviti (or similar vendor platforms) and validating measure outputs
• Experience managing NCQA IDSS submissions and ensuring audit-ready technical deliverables

Contact:
Karrie Ruch
kruch@jacobsongroup.com

Pay Range:
The anticipated pay range for this position is $60.00 - $60.00 per hour. We understand salary is an important factor in a job search, and we encourage you to apply even if you feel that your desired compensation may fall outside of the listed range. The final pay for this position is determined based on several factors including but not limited to, relevant experience, skills and certifications, education and training, geographic location, market conditions, and internal equity. We are committed to finding the right candidate for this role and are open to discussing how your unique qualifications align with our needs.

Benefits:

• Medical insurance.
• Dental insurance.
• Vision insurance.
• 401(k) retirement savings plan.

Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs. If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at HR@jacobsongroup.com or +1 (800) 466-1578 to make a request.

Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!