Healthcare Analytics & Methodology Leadership
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Define, analyze, document, and maintain healthcare quality and utilization methodologies, ensuring consistency across product, analytics, and reporting solutions.
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Interpret and operationalize CMS quality program requirements, including ASCQR, OQR, HQR, and related healthcare quality initiatives.
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Evaluate methodology changes based on regulatory updates, coding revisions, and industry standards.
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Develop clear rationale and business context behind methodology decisions and communicate them effectively to stakeholders.
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Validate implemented analytics against documented specifications to ensure consistency across code, documentation, and system outputs.
Business Analysis & Solution Design
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Collaborate with Product Managers, Data Scientists, Engineers, and Clinical SMEs to translate business and regulatory requirements into functional specifications.
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Analyze healthcare claims, encounters, and clinical datasets to identify trends, data dependencies, and business opportunities.
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Define business requirements, user stories, acceptance criteria, and process workflows supporting healthcare analytics solutions.
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Facilitate requirement gathering sessions, stakeholder workshops, and cross-functional discussions.
Quality Measure Development & Validation
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Review and validate measure definitions, attribution methods, exclusions, numerators, denominators, and benchmarking approaches.
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Ensure analytic methodologies align with healthcare quality measurement standards and governance requirements.
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Support measure development and enhancement activities, including emerging eCQMs and value-based care measures.
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Perform detailed gap analysis and impact assessments for methodology updates.
Data Analysis & Regulatory Compliance
Internal - General Use
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Work hands-on with SQL and analytic tools to validate methodology outputs and investigate discrepancies.
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Assess the impact of coding updates, including diagnosis, procedure, and quality reporting changes.
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Conduct data validation and root cause analysis for client-reported issues and internal quality reviews.
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Support audit readiness and maintain traceability for all methodology-related changes.
Stakeholder & Client Engagement
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Partner with client-facing teams to investigate, explain, and resolve methodology and data-related questions.
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Present methodology decisions, findings, and recommendations to leadership, clients, and cross-functional teams.
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Build trusted relationships with stakeholders through clear communication, transparency, and defensible analytical approaches.
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Support implementation activities and provide subject matter expertise during client onboarding and solution adoption.
Required Qualifications
Education & Experience
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Bachelor's degree in Business Management, Information Systems, Healthcare Administration, Healthcare Informatics, or a related field; or equivalent work experience.
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5+ years of experience in Healthcare, IT, Healthcare Analytics, or related industries.
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3+ years of experience as a Business Analyst supporting software development initiatives.
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3+ years of experience working with healthcare claims and encounter data.
Healthcare Analytics Expertise
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Deep knowledge of healthcare analytics methodologies, including:
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Measure definitions
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Attribution methodologies
Internal - General Use
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Numerators and denominators
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Exclusions and stratifications
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Risk adjustment principles
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Expertise in CMS quality programs such as:
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Ambulatory Surgery Center Quality Reporting (ASCQR)
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Outpatient Quality Reporting (OQR)
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Hospital Quality Reporting (HQR)
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Strong understanding of:
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Cost of Care
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Quality of Care
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Utilization Management
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Value-Based Care
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Population Health and Health Risk Analytics
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Experience creating and maintaining methodology documentation, concept specifications, mapping specifications, and version-controlled methodology updates.
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Ability to validate analytic output against technical and business specifications.
Technical Skills
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Robust SQL and data analysis capabilities.




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

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