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Overview:

Overview

The IT HEDIS Manager is responsible for leading the technology, data integration, platform operations, and technical validation functions that support the organization’s HEDIS program. This role manages ETL developers and operational support staff while serving as a key IT partner to HEDIS, Quality, business, vendor, audit, and project stakeholders. The manager oversees HEDIS data feeds, production operations, platform support, data-quality controls, technical documentation, vendor coordination, audit support, and reporting deliverables. This role will also support a major HEDIS engine replacement initiative, including migration from the current Inovalon/Cotiviti environment to a future-state platform with Arcadia supporting portions of HEDIS and NCQA-related functionality.

Education

• Bachelor’s degree in Information Technology, Computer Science, Data Management, Healthcare Administration, or a related field (Preferred)

or

• 7+ years relevant experience may be accepted in lieu of degree

Certification/Licensure

• No specific certification or licensure requirements

Experience

• Seven or more years of experience in healthcare data, payer technology, analytics, data warehousing, quality measurement, HEDIS operations, or related IT functions (required )

• Three or more years of leadership experience managing ETL, data engineering, technical operations, analytics, production support, or similar teams, including direct oversight of staff (required)

• Experience supporting HEDIS data processing, reporting, validation, audits, quality-measurement platforms, or HEDIS engine implementation, replacement, migration, or parallel-validation activities(Required)

• Strong knowledge of payer enrollment, claims, encounters, pharmacy, provider, laboratory, clinical, supplemental data, ETL, SQL, data warehouses, Databricks, file-based integrations, APIs, testing, reconciliation, and production support.

• Experience working with HEDIS-related vendors or platforms such as Arcadia, Cotiviti, Inovalon, or comparable systems, with the ability to communicate technical issues clearly to business, vendor, audit, project, and executive stakeholders.(preferred)

• Experience supporting an NCQA HEDIS compliance audit.(preferred)

• Knowledge of ECDS, digital HEDIS measures, FHIR, HIE integration, and clinical-data exchange

Keywords: LinkedIn , HEDIS, Cotiviti, Innovalan,Arcadia

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.