Healthcare Analytics & Methodology Leadership
•
Define, analyze, document, and maintain healthcare quality and utilization methodologies, ensuring consistency across product, analytics, and reporting solutions.
•
Interpret and operationalize CMS quality program requirements, including ASCQR, OQR, HQR, and related healthcare quality initiatives.
•
Evaluate methodology changes based on regulatory updates, coding revisions, and industry standards.
•
Develop clear rationale and business context behind methodology decisions and communicate them effectively to stakeholders.
•
Validate implemented analytics against documented specifications to ensure consistency across code, documentation, and system outputs.
Business Analysis & Solution Design
•
Collaborate with Product Managers, Data Scientists, Engineers, and Clinical SMEs to translate business and regulatory requirements into functional specifications.
•
Analyze healthcare claims, encounters, and clinical datasets to identify trends, data dependencies, and business opportunities.
•
Define business requirements, user stories, acceptance criteria, and process workflows supporting healthcare analytics solutions.
•
Facilitate requirement gathering sessions, stakeholder workshops, and cross-functional discussions.
Quality Measure Development & Validation
•
Review and validate measure definitions, attribution methods, exclusions, numerators, denominators, and benchmarking approaches.
•
Ensure analytic methodologies align with healthcare quality measurement standards and governance requirements.
•
Support measure development and enhancement activities, including emerging eCQMs and value-based care measures.
•
Perform detailed gap analysis and impact assessments for methodology updates.
Data Analysis & Regulatory Compliance
Internal - General Use
•
Work hands-on with SQL and analytic tools to validate methodology outputs and investigate discrepancies.
•
Assess the impact of coding updates, including diagnosis, procedure, and quality reporting changes.
•
Conduct data validation and root cause analysis for client-reported issues and internal quality reviews.
•
Support audit readiness and maintain traceability for all methodology-related changes.
Stakeholder & Client Engagement
•




Partner with client-facing teams to investigate, explain, and resolve methodology and data-related questions.
•
Present methodology decisions, findings, and recommendations to leadership, clients, and cross-functional teams.
•
Build trusted relationships with stakeholders through clear communication, transparency, and defensible analytical approaches.
•
Support implementation activities and provide subject matter expertise during client onboarding and solution adoption.
Required Qualifications
Education & Experience
•
Bachelor's degree in Business Management, Information Systems, Healthcare Administration, Healthcare Informatics, or a related field; or equivalent work experience.
•
5+ years of experience in Healthcare, IT, Healthcare Analytics, or related industries.
•
3+ years of experience as a Business Analyst supporting software development initiatives.
•
3+ years of experience working with healthcare claims and encounter data.
Healthcare Analytics Expertise
•
Deep knowledge of healthcare analytics methodologies, including:
o
Measure definitions
o
Attribution methodologies
Internal - General Use
o
Numerators and denominators
o
Exclusions and stratifications
o
Risk adjustment principles
•
Expertise in CMS quality programs such as:
o
Ambulatory Surgery Center Quality Reporting (ASCQR)
o
Outpatient Quality Reporting (OQR)
o
Hospital Quality Reporting (HQR)
•
Strong understanding of:
o
Cost of Care
o
Quality of Care
o
Utilization Management
o
Value-Based Care
o
Population Health and Health Risk Analytics
•
Experience creating and maintaining methodology documentation, concept specifications, mapping specifications, and version-controlled methodology updates.
•
Ability to validate analytic output against technical and business specifications.
Technical Skills
•
Strong SQL and data analysis capabilities.




•
Experience validating complex healthcare methodologies using claims, encounter, and clinical datasets.
•
Ability to evaluate and incorporate medical coding updates into analytic methodologies.
•
Knowledge of benchmarking methodologies and comparative analytics.
•
Familiarity with healthcare data models and reporting frameworks.
Communication & Leadership
•
Excellent analytical, problem-solving, and documentation skills.
•
Strong verbal and written communication abilities.
Internal - General Use
•
Ability to explain complex analytical concepts to both technical and non-technical audiences.
•
Experience presenting methodology decisions and findings to senior leadership and external clients.
Preferred Qualifications
Ambulatory & Patient Safety Analytics
•
Deep understanding of ambulatory, outpatient, and post-acute care data domains.
•
Experience working with:
o
Office and Clinic Visits
o
Hospital Outpatient Departments (HOPD)
o
Ambulatory Surgery Centers (ASC)
o
Skilled Nursing Facilities (SNF)
o
Home Health and Post-Acute Care datasets
•
Knowledge of patient safety and quality measures represented within EHR/EMR systems.
•
Ability to assess data availability, data lineage, and feasibility for ambulatory quality measures.
Clinical & Quality Measurement Expertise
•
Clinical credential or background such as:
o
Physician
o
Registered Nurse (RN)
o
Advanced Practice Provider
o
Clinical Quality Leader
o
Senior Clinical Analytics Qualified
•
Experience developing or evaluating clinical quality measures and outcomes metrics.
•
Knowledge of provider performance measurement methodologies.
•
Familiarity with risk-adjusted and case-mix-adjusted performance reporting.
Internal - General Use
•
Ability to assess measures for clinical relevance, fairness, and validity.
Industry Knowledge
•
Experience supporting healthcare quality reporting, regulatory analytics, or population health initiatives.
•
Understanding of healthcare quality frameworks, accreditation standards, and CMS reporting requirements.
•
Familiarity with value-based payment models and quality incentive programs

📌 Healthcare Analytics (Bengaluru)
🏢 GK HR Consulting India Private
📍 Bengaluru