HEDIS Data Quality Lead Program Manager

001_BCBSA Blue Cross and Blue Shield Association; Washington, Chicago (District of Columbia, IL); Hybrid; USD 113,000 - 153,000; Full time

Benefits offered by this job

Annual bonus incentive pay

Paid time off

11 holidays

Medical/dental/vision insurance

Generous 401(k) matching

Lifestyle spending account

Job summary

Blue Cross Blue Shield Association (BCBSA) oversees HEDIS data quality and reporting strategies to optimize NCQA submissions. The role coordinates cross-functional teams, supports QA testing, and drives data improvements across plans and vendors.

The candidate will analyze data to enhance HEDIS operations, develop methodologies, and prepare content for stakeholder presentations and conferences. A Bachelor's degree and 7+ years in healthcare operations are required.

Qualifications

• Bachelor's degree or equivalent experience is required.
• 7+ years in a business environment with managed care/health services experience.
• Strong communication and interpersonal skills across audiences.
• Advanced analytic skills with the ability to analyze and interpret data.
• Knowledge of HEDIS data, HEDIS measures, and healthcare informatics is preferred.

Responsibilities

• Develop, communicate, and monitor quality performance standards for plans and FEPI; focus on HEDIS data strategy and reporting.
• Support end-to-end testing for compliance and efficiency improvements; liaise with partners to optimize data and resolve defects.
• Create and deliver presentations, reports, and materials; support project management and conferences for accurate system and process execution.
• Develop accurate HEDIS processes and maintain relationships with Quality departments; resolve complex data issues and document methodologies.

Skills

Excellent communication

Advanced analytic skills

Data mining

Curiosity and determination

Healthcare operations knowledge

Education

Bachelor's degree

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.

Key Responsibilities

• 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.

Salary Range

113,007.88 - 152,825.99

Education, Certifications and Experience

Education: Required Bachelor's Degree ; or equivalent experience

Experience: 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 informatics

Knowledge, 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)
• 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 informatics
• Experience with quality measurement experience (to include HEDIS measures and clinical quality)

#LI_HYBRID

The 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.

Bonuses

• This job is also eligible for annual bonus incentive pay.

Benefits

• paid time off
• 11 holidays
• medical/dental/vision insurance
• generous 401(k) matching
• lifestyle spending account
• 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.

About Blue Cross Blue Shield Association (BCBSA)

At Blue Cross Blue Shield Association (BCBSA), we are a national association of 33 independent, community-based and locally operated Blue Cross Blue Shield companies and we are driven by purpose. Join the team who supports the nation's largest healthcare network, providing coverage to nearly one in three Americans as we relentlessly pursue affordable healthcare and ensure peace of mind for the people we serve. Be part of our storied history of innovation as we advance well-being and health equity.

Experience a culture that is built on our core values, connection, work-life flexibility, well-being, and a commitment to our community. If you thrive at a company that values inclusivity, accountability, courage, teamwork, and respect, we're glad you found us!