HEDIS Data Quality Lead Program Manager

Blue-Cross-Blue-Shield-Association; Chicago (IL); Hybrid; USD 113,000 - 153,000; Full time

Benefits offered by this job

Paid time off

11 holidays

Medical/dental/vision insurance

401(k) matching

Lifestyle spending account

Job summary

Blue-Cross-Blue-Shield-Association seeks a HEDIS Data Quality Specialist to lead data quality strategy, oversee HEDIS portal, and drive performance improvements with cross-functional teams. The role supports HEDIS reporting for NCQA and FEHBP, utilizing SAS, SQL, Cognos, and MCSource for advanced analytics.

The position emphasizes end-to-end testing, data integrity, and effective communication with business partners to optimize data and address defects.

Qualifications

• Bachelor's degree or equivalent required.
• 7+ years in a business environment, managed care, or health services delivery with expertise in health care operations, claims processing, and healthcare informatics.
• Strong communication and interpersonal skills; ability to present to audiences internal/external to BCBS A.
• Advanced analytic skills for data interpretation and insights.

Responsibilities

• Support and execute the HEDIS data quality strategy for optimal HEDIS submission to NCQA.
• Oversee HEDIS portal, QCR data profiling, and HEDIS reporting; coordinate with stakeholders.
• Develop and monitor quality performance standards for plans and FEHBP; drive year‑round HEDIS data strategy.
• Perform data mining and analyses to identify opportunities for performance improvement in HEDIS operations.
• Create presentations and content for conferences; support project management and implementation.

Skills

Analytic skills

Communication skills

Data analysis

Curiosity

Education

Bachelor's degree or equivalent

Tools

SAS

SQL

Cognos

MCSource

Job description

Job Description Summary:This position supports and executes the Healthcare Effectiveness Data and Information Set (HEDIS) data quality strategy for optimal HEDIS submission to National Committee for Quality Assurance (NCQA). Responsibilities include oversight of the HEDIS portal, QCR data profiling and HEDIS reporting. Will work cross functionally coordinating and driving quality performance amongst all stakeholders. As a subject matter expert possesses extensive knowledge of HEDIS technical specifications assisting Plans and vendors with data improvement strategies to optimize QCR service charge. Carries out extensive data mining and analyses utilizing analytic tools and applications to identify opportunities for performance improvement in all aspects of HEDIS operations.Responsibilities include but are not limited to:Clinical Quality Technical Strategy: Develop, communicate, and monitor quality performance standards for plans and the Federal Employee Program, while creating a year-round HEDIS data strategy focusing on PDR integration, QCR measures, and reporting. Continuously analyze data to improve HEDIS operations, ensure systems meet changing requirements, and educate teams on annual technical changes.Clinical Quality Technical Operations: Support end-to-end testing for compliance and efficiency improvements, leveraging application architecture and maintaining reference materials for continuous feedback. Communicate with business partners to optimize data, address defects, and implement resolutions.Clinical Quality Business Operations: Create and deliver presentations, reports, and summary materials, while supporting project management and implementation. Collaborate with partners and prepare content for conferences to ensure accurate system and process execution.Clinical Quality Assurance: Develop accurate HEDIS processes and maintain relationships with Quality departments and teams to support HEDIS reporting. Resolve complex data issues, ensure analysis integrity, and create methodology documents.The posting range for this position is:113,007.88 - 152,825.99Required Education, Certifications and Experience:Education:Required Bachelor's Degree ; or equivalent experienceExperience:Required 7+ Years within a business environment, a managed care or health services delivery setting with expertise in health care operations, claims processing, and healthcare informaticsKnowledge Skills and Abilities:Excellent communication (written and oral) and interpersonal skills with an ability to communicate to small and/or large audiences (both internal and external to BCBSA)Advanced analytic skills with the ability to analyze and interpret data through complex analysis.Demonstrate curiosity and determination in pursuing complex and innovative approaches to data analyses.Knowledge of SAS, SQL, Cognos, or MCSource.Demonstrated ability to apply strong analytic / financial skills, with the knowledge of applications and technology commonly used in health care (e.g., clinical, administrative, financial, consumer, business intelligence, data integration, privacy and security)Certifications & Licenses:Preferred: Legal, Risk, Contracts & Governance\AHIP - Professional, Academy for Health Care Management (PAHM)Preferred: Healthcare / Insurance\AHIP - Managed Healthcare Professional (MHP)Additional Preferred Experience:Five or more years of experience within a business environment, a managed care or health services delivery setting with expertise in health care operations, claims processing, and healthcare informaticsExperience with quality measurement experience (to include HEDIS measures and clinical quality)#LI_HYBRIDThe posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.