Job Description

SpectraMedix is a leading healthcare analytics organization dedicated to empowering health plans and providers in their transition to value-based care. Our VBP Analytics Suite offers actionable insights into quality, risk, utilization, and financial performance, enabling stakeholders to execute intricate value-based arrangements effectively.

Job Title: Senior Healthcare Data Analyst
Location: East Windsor, NJ (Remote acceptable)
Experience Level: 6–8 Years
Employment Type: Full-time

Job Description

Role Overview

We are looking for an experienced  Senior Healthcare Data Analyst  with a strong understanding of healthcare data, payer operations, and clinical quality measurement. The ideal candidate will be proficient in SQL and have extensive experience working with  HEDIS  measures,  claims , and  payer data sets  to drive performance in value-based models.

Key Responsibilities

• Analyze and report on  HEDIS ,  eCQM ,  Stars , and other quality measures.
• Extract and analyze healthcare data from multiple sources (e.g., claims, enrollment, EMR).
• Develop and maintain documentation for business requirements, data mapping, and specifications.
• Work with business stakeholders to understand and deliver quality-focused data insights.
• Support UAT, data validation, and test case development.
• Collaborate with teams for planning, design, and enhancement of analytics solutions.
• Participate in internal and client reviews related to measure specifications and compliance.

Qualifications

• 6–8 years of experience as a Business/Data Analyst in  US Healthcare , particularly  payers or health plans .
• Proficient in SQL for data extraction and analytics.
• In-depth knowledge of healthcare codes and formats:  ICD-10, CPT, HCPCS, 837I/P, HL7, FHIR .
• Hands-on experience with  HEDIS ,  eCQMs ,  MIPS ,  DSRIP , etc.
• Strong understanding of  payer data : member/enrollment, claims, revenue, risk adjustment.
• Graduate or Postgraduate degree in Public Health, Health Informatics, Hospital/Health Administration, Pharmacy, or related field.
• Strong written/verbal communication and technical documentation skills.
• Ability to work independently and manage multiple priorities in a fast-paced environment.

Additional Information

Nice to Have

• Experience in  value-based care or  risk-based contracting analytics.
• Familiarity with  clinical integration platforms ,  NCQA audit processes , or  population health solutions .

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