[Remote] Senior Value-Based Healthcare Data Analyst - Remote
Note: The job is a remote job and is open to candidates in USA. Optum is part of Kelsey-Seybold Clinic, one of the nation's leading healthcare organizations, offering coordinated and accountable care. The Senior Value-Based Healthcare Data Analyst will provide leadership and advanced analytical expertise to support healthcare quality and regulatory reporting initiatives while ensuring the accuracy and compliance of complex healthcare data.
Responsibilities
- Providing leadership and advanced analytical expertise to support healthcare quality, regulatory, and operational reporting initiatives, including HEDIS, EDPS, and encounter submissions
- Ensuring accuracy, integrity, traceability, and compliance of complex, multi source healthcare data in accordance with NCQA, CMS, and state regulatory requirements
- Functioning as a hands on technical leader, supervising analytic activities and coordinating efforts across Quality, Clinical, Informatics, IT, and Business Intelligence teams
- Supporting organizational objectives related to quality performance, affordability, and improved member outcomes through collaboration and data driven insights
Skills
- Bachelor's degree in Health Informatics, Healthcare Administration, Data Analytics, Statistics, Computer Science, Information Systems, Mathematics, or a related discipline
- 3+ years of experience in healthcare data analytics, informatics, decision support, or managed care, including project leadership or analyst mentoring
- Experience supporting NCQA HEDIS Compliance Audits, quality measurement, and value-based care programs
- Experience supporting Medicare Advantage (Part C) and/or Health Insurance Marketplace products
- Experience extracting, reconciling, and validating data from EPIC Clarity and/or Caboodle
- Solid experience with data validation, ETL processes, and healthcare reporting tools (eg, Tableau, Power BI, Crystal Reports)
- Knowledge of Medicare Advantage, including Stars, HEDIS, and regulatory reporting programs
- Advanced expertise in healthcare data analytics, quality measurement, and regulatory compliance
- Understanding of HEDIS Technical Specifications, NCQA requirements, and related compliance standards
- Proficiency working with claims and clinical data, including ICD 10 CM and CPT/HCPCS coding standards and healthcare data models
- Advanced proficiency in SQL and Microsoft Excel, with working knowledge of Word and PowerPoint
- Demonstrated ability to translate complex healthcare data into clear, executive level insights that support quality and performance strategy
- Demonstrated ability to manage multiple priorities in a fast paced, deadline driven environment
- Proven verbal and written communication skills with exceptional attention to detail and analytical rigor
- Proven independently monitors data pipelines, submissions, and measure results for anomalies, gaps, or logic errors
- Master's degree in health informatics, Data Science, Analytics, Biostatistics, Healthcare Administration, or related field
- Relevant certifications such as CPHQ, RHIA/RHIT, Epic (Clarity/Caboodle/reporting), CAP, or SAS/SQL/data analytics
- 3+ years of experience with EDI encounter data (837), acknowledgments (277CA/999), and CMS risk adjustment files (MAO 002/004, RAPS)
- Experience reviewing work and providing actionable feedback
- Solid expertise in healthcare analytics, quality metrics, and value-based care models
- Advanced knowledge of Epic Clarity architecture, refresh cycles, and EDW integration for BI/reporting
- Proficiency in Python, R, SAS, or similar programming/statistical tools
- Demonstrated ability to balance strategic thinking with hands-on execution
- Proven problem-solving skills with a focus on continuous improvement and proactive solution development
- All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
Company Overview
Company H1B Sponsorship