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
Optum provides primary care and optical care services. It was founded in 1985, and is headquartered in Albuquerque, New Mexico, USA, with a workforce of 10001+ employees. Its website is https://nm.optum.com.Company H1B Sponsorship
Optum has a track record of offering H1B sponsorships, with 73 in 2026, 648 in 2025, 559 in 2024, 620 in 2023, 851 in 2022, 593 in 2021, 438 in 2020. Please note that this does not guarantee sponsorship for this specific role.