Hiring Business Analyst (HEDIS Compliance & Performance Specialist) in Louisville

PTCIT is a specialized healthcare technology consulting firm that partners with Medicare Advantage organizations, health systems, and government health programs across the United States to optimize regulatory compliance, improve quality measurement outcomes, and streamline operational workflows. Over the past 12 years, we have supported more than 70 health plans and provider groups to meet Centers for Medicare & Medicaid Services (CMS) requirements, reduce compliance risk, and improve Medicare Star Ratings scores that directly impact provider reimbursement rates and member care quality.

We are currently seeking an experienced Business Analyst with specialized expertise in the Healthcare Effectiveness Data and Information Set (HEDIS) framework to join our full-time onsite team in Louisville, Kentucky. This role is designed for a detail-oriented analyst with hands-on experience working with HEDIS measure specifications, CMS reporting requirements, and healthcare claims data to drive actionable, measurable improvements for our clients. Unlike generic business analysis roles, this position offers direct exposure to high-stakes healthcare regulatory projects that impact millions of beneficiaries, with clear, structured pathways to advance into senior compliance, product management, or client leadership roles.

Key responsibilities for this role include:
1. Lead end-to-end HEDIS measure validation and reporting for 3-5 concurrent Medicare Advantage and commercial health plan clients, ensuring 100% alignment with annual CMS HEDIS measure specifications and submission deadlines, with a track record of reducing measure error rates by at least 15% year-over-year for assigned portfolios.
2. Analyze 500K+ rows of healthcare claims, enrollment, and provider data monthly using SQL and data visualization tools to identify gaps in HEDIS measure compliance, document root causes of measure gaps, and recommend targeted process adjustments for client care management and claims processing teams.
3. Collaborate with client clinical, operations, and data engineering teams to translate HEDIS regulatory requirements into clear, actionable business requirements, including drafting functional requirement documents (FRDs), process flow diagrams, and user acceptance testing (UAT) criteria for new reporting and care gap closure tools.
4. Own the end-to-end lifecycle of HEDIS-related project tasks in Jira, including backlog prioritization, sprint planning, stakeholder status updates, and issue resolution, ensuring 95% of assigned project milestones are delivered on time and within scope for quarterly client reviews.
5. Conduct quarterly HEDIS compliance audits for client provider networks, identifying gaps in documentation, coding, and care gap closure processes, and deliver data-backed training sessions for 20+ care coordinators and medical coding staff per client to improve measure capture rates.
6. Partner with CMS reporting teams to prepare and submit annual HEDIS data files, resolve CMS query responses within 48 business hours, and support mock audits to reduce the risk of formal compliance findings for clients, with a proven track record of zero material HEDIS audit findings for assigned accounts in the last 2 years.
7. Develop and maintain interactive HEDIS performance dashboards in Tableau for client executive stakeholders, tracking measure performance against CMS Star Ratings targets, identifying trend lines for high-impact measures, and presenting monthly performance reviews to C-suite and operations leadership.
8. Stay up to date with annual CMS HEDIS measure updates, Medicare Advantage policy changes, and Star Ratings methodology adjustments, and lead internal knowledge-sharing sessions for the 12-member business analysis team to ensure consistent implementation of new requirements across all client accounts.

Our Louisville office is located in the downtown healthcare corridor, with a collaborative open workspace designed for cross-team project work. This role requires full onsite presence to support client workshops, in-person stakeholder meetings, and cross-functional team alignment sessions. We prioritize a culture of continuous learning and work-life balance: all analysts receive dedicated weekly time for professional development, access to paid certification support (including Certified HEDIS Professional (CHP) and Certified Professional in Healthcare Quality (CPHQ) credentials), and a flat organizational structure where team members at all levels are encouraged to contribute to client solution design. We do not enforce unnecessary overtime, and our project management teams work closely with analysts to balance workloads during peak HEDIS reporting seasons (January through March) with flexible time off options during slower quarters. Our team is composed of 60% healthcare industry veterans and 40% early-career analysts, with formal 6-month mentorship pairings for all new hires to support onboarding and long-term career growth.

To qualify for this role, you must have a minimum of 5 years of professional experience in healthcare business analysis, with at least 3 years of hands-on experience working with HEDIS measure specifications, CMS reporting requirements, and Medicare Advantage plan operations. You must demonstrate proficiency in analyzing large healthcare datasets using SQL, and have a working knowledge of healthcare data standards including ICD-10, CPT, and HCPCS coding. Strong stakeholder communication skills are critical, as you will present technical findings to non-technical clinical and executive audiences on a weekly basis. Candidates with experience working with US healthcare payers, provider groups, or consulting firms supporting the Medicare/Medicaid ecosystem will be prioritized. All candidates must be legally authorized to work in the United States, and willing to travel up to 10% of the time for occasional client on-site visits outside of Louisville.

Required technical proficiencies for this role include advanced SQL for data querying and manipulation, Tableau or Power BI for dashboard development, Jira for project and issue tracking, and advanced proficiency in Microsoft Office Suite (including pivot tables, VLOOKUP, and macros) for data analysis and reporting. Familiarity with healthcare data interoperability standards including HL7 and FHIR, experience with EHR systems including Epic or Cerner, and experience with SAS or R for statistical analysis of HEDIS measure performance, are considered strong pluses.

We offer a competitive base salary range of $78,000 to $102,000 per year, adjusted based on years of HEDIS-specific experience and relevant professional certifications. All full-time employees receive a comprehensive benefits package including 100% employer-paid health, dental, and vision insurance for employees and 80% coverage for dependents, a 401(k) plan with 4% employer match, 20 days of paid time off plus 10 paid company holidays, and a $2,000 annual professional development stipend to cover certification courses, conference attendance, or industry membership fees. We also offer flexible scheduling options during non-peak reporting periods, and a $100 monthly transit stipend for employees commuting to our downtown Louisville office.

This role is designed as a stepping stone to both senior individual contributor and leadership tracks within our healthcare consulting practice. Top performers in this role are eligible for promotion to Senior Business Analyst within 18 months of hire, with a corresponding salary increase of 10-15%, and are prioritized for selection to lead cross-client HEDIS process improvement projects. After 3 years of strong performance, you may be eligible to move into Healthcare Compliance Lead, Client Delivery Manager, or Product Management roles focused on HEDIS and quality measurement solutions, with dedicated leadership training and mentorship from our practice directors. We also support internal transfers to other healthcare consulting verticals including Medicare Star Ratings optimization, Medicaid compliance, and value-based care program design, for analysts looking to broaden their expertise.

Our hiring process for this role consists of three stages: an initial 30-minute phone screen with our talent acquisition team to confirm basic qualifications and role fit, a 60-minute technical interview with our HEDIS practice lead to assess your experience with HEDIS measure specifications and data analysis skills, and a final 45-minute behavioral interview with the client delivery director to evaluate your stakeholder communication and project management capabilities. We aim to extend offers to qualified candidates within 10 business days of receiving a completed application, with a target start date of 3 weeks after offer acceptance. To apply, please send your resume and a brief 2-3 sentence summary of your most impactful HEDIS project to [email protected] with the subject line "Business Analyst HEDIS Application - [Your Full Name]". We review all applications on a rolling basis, and will contact you within 5 business days of receiving your submission to confirm next steps. We do not accept unsolicited phone calls regarding this role, and will only reach out to candidates who meet the minimum qualification requirements.