Lead analytics for value-based care quality and regulatory reporting (HEDIS, EDPS, encounters). Ensure data integrity from EPIC Clarity/Caboodle, manage ETL/validation, produce executive insights, supervise analytic work, and coordinate cross-functional efforts to support Medicare Advantage, quality performance, and compliance with NCQA/CMS standards.
Requisition Number: 2366461
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.
The Senior Value-Based Healthcare Data Analyst is responsible for providing leadership and advanced analytical expertise to support healthcare quality, regulatory, and operational reporting initiatives, including HEDIS, EDPS, and encounter submissions. This position ensures accuracy, integrity, traceability, and compliance of complex, multi source healthcare data in accordance with NCQA, CMS, and state regulatory requirements. The role functions as a hands on technical leader, supervising analytic activities and coordinating efforts across Quality, Clinical, Informatics, IT, and Business Intelligence teams. Through collaboration and data driven insights, the position supports organizational objectives related to quality performance, affordability, and improved member outcomes.
If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges.
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Preferred Qualifications:
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.
The Senior Value-Based Healthcare Data Analyst is responsible for providing leadership and advanced analytical expertise to support healthcare quality, regulatory, and operational reporting initiatives, including HEDIS, EDPS, and encounter submissions. This position ensures accuracy, integrity, traceability, and compliance of complex, multi source healthcare data in accordance with NCQA, CMS, and state regulatory requirements. The role functions as a hands on technical leader, supervising analytic activities and coordinating efforts across Quality, Clinical, Informatics, IT, and Business Intelligence teams. Through collaboration and data driven insights, the position supports organizational objectives related to quality performance, affordability, and improved member outcomes.
If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges.
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- 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
Preferred Qualifications:
- 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
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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