Note: The job is a remote job and is open to candidates in USA. Dice is part of the Optum family of businesses, which is one of the nation's leading health care organizations. The Senior Value-Based Healthcare Data Analyst is responsible for providing leadership and advanced analytical expertise to support healthcare quality and operational reporting initiatives, ensuring compliance with regulatory requirements and improving member outcomes.

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

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

Benefits

• A comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

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