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Department

* Must Live in Colorado

*This is a hybrid role located in Denver, Colorado with a requirement of being in the office 2 days per week.

Job Summary

This position serves as the technical owner of Healthcare Effectiveness Data and Information Set (HEDIS) outputs from the HEDIS Engine, ensuring accuracy, completeness, and audit readiness of all measure results and working with the HEDIS Clinical Lead to interpret new measure specifications.

The HEDIS Technical Lead is responsible for end-to-end execution of HEDIS measurement, validation, and submission, with a primary focus on HEDIS Engine (Cotiviti) production, rate validation, and NCQA IDSS submission for Denver Health Medical Plan (DHMP). The ideal candidate has hands-on experience running HEDIS cycles in Cotiviti (or similar vendor platforms), validating measure outputs, and managing IDSS submissions, and can partner effectively with data warehouse and clinical team. This role ensures that all HEDIS data is accurate, complete, traceable, and audit-ready.

Essential Functions:

• HEDIS Technical Execution
  • Serves as Technical Lead on HEDIS Production and Submission Lifecycle
  • Partners with Clinical Lead for strategy development of HEDIS Program
  • Manages test, early production, and production run sequencing
  • Oversees ingestion of claims, encounters, enrollment, provider, and SDS data
  • Ensures data integrity, traceability, and documentation of data flows within the HEDIS Engine
  • Works directly with HEDIS Engine staff to ensure issues are resolved timely
  (40%)
• Supplemental Data Sources (SDS)
  • Partner with Clinical Lead and internal IT Teams for technical implementation of new and existing SDS
  • Partners with business/clinical stakeholders to translate requirements into technical design
  • Supports mapping, validation, PSV preparation, and remediation
  • Troubleshoots SDS-related issues during runs and audit (20%)
• QA / UAT (Technical)
  • Owns technical QA/UAT for:
  o Measure output validation and variance analysis
  o CAHPS sample generation and technical files
  • Confirms technical outputs align with HEDIS specifications and business expectations (10%)
• Submissions & File Management
  • Owns technical aspects of submissions, including:
  o Cotiviti output files
  o Attest uploads
  o NCQA IDSS technical files (XML/CSV)
  o State submissions, as applicable
  • Ensures submissions are complete, timely, and compliant (20%)
• Audit & Issue Resolution
  • Provides technical evidence and analysis for audit requests
  • Performs root cause analysis for discrepancies or findings
  • Maintains technical documentation to support audit defense and continuity
  (10%)

Education:

• Bachelor’s degree in data analytics, information systems, computer science, or related field required

Work Experience:

• 4-6 years experience in health care data analytics, with at least 3 years focused specifically on HEDIS-specific technical experience in a health plan or similar environment required
• 1-3 years experience supporting data validation, QA/UAT, and/or audits required
• 1-3 years ability to communicate technical concepts to non-technical stakeholders and collaborate effectively across departments required
• 1-3 years strong SQL and data analysis skills required

Licenses:

Knowledge, Skills and Abilities:

• Strong knowledge of NCQA HEDIS specifications, CMS Star Ratings, and regulatory reporting to State and Federal programs.
• Direct experience with HEDIS software tools (e.g., Inovalon QSI-XL, Cotiviti, OnPoint, or other vendors).
• In-depth knowledge of HEDIS lifecycle, including NCQA IDSS submission formats and requirements.
• Familiarity with data from clinical systems (e.g., EMR/EHR), claims, encounters, and supplemental data sources.
• Experience supporting HEDIS audits and PSV processes.
• Excellent problem-solving, communication, multi-disciplinary collaboration and project management skills.
• Proficiency in Microsoft Office (Excel, PowerPoint, Word).
• Accuracy and attention to detail in data analysis and reporting.
• Proven ability to meet deadlines and manage deliverables.
• Ability to work independently and manage multiple competing priorities in a fast-paced environment.
• Experience working with Medicaid, Exchange, Medicare Advantage, or Dual Eligible populations, preferred
• Knowledge of risk adjustment, care gaps, or other quality-related initiatives such as CAHPS or Health Outcomes Survey (HOS), preferred
• Advanced proficiency with SQL (Oracle, SQL Server, or similar), with experience writing complex queries and optimizing data pipelines, preferred
• Experience using reporting and data visualization tools (e.g., Tableau, Power BI, SAS, R, Python), preferred

* Must Live in Colorado

*This is a hybrid role located in Denver, Colorado with a requirement of being in the office 2 days per week.

Shift

Work Type

Salary

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays

• 100% paid parental leave up to 6 weeks

• Immediate eligibility for retirement plans with employer contribution up to 9.5%

• Generous medical, dental, vision plans in addition to employer paid disability and life insurance.

• Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center

• Free RTD EcoPass (public transportation)

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.

As Colorado’s primary, and essential, safety-net health care system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.

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About Denver Health

Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation's leaders in medicine.Denver Health is an Equal Opportunity Employer At Denver Health we pride ourselves on our commitment to diversity. Equal opportunity is a fundamental principle of Denver Health. As an equal opportunity employer, Denver Health is committed to recruit, hire, promote and administer all human resource actions in a non-discriminatory manner. Denver Health is committed to providing equal opportunities in all business practices and to all persons regardless of age, race, color, national origin, genetic information, religion, sex, pregnancy, disab...ility, sexual orientation, gender identity, gender expression, marital status or veteran status (collectively “protected status”). Denver Health strives to maintain a work environment that is free from unlawful harassment and discrimination and will not tolerate any such conduct by employees or directed at employees within the scope of their employment. Read the full Human Resources Employee Principles and Practices policy.

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