HEDIS Program Lead & Training Specialist — Hybrid

Blue Cross Blue Shield of Arizona; United States; Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Cross Blue Shield of Arizona is seeking a qualified professional to lead NCQA HEDIS data retrieval, review, and overread initiatives. You will design, pilot, and monitor projects, and ensure timely reporting and remediation of gaps. This is a full-time, hybrid role based in Arizona.

You will train staff, manage data sources, and coordinate with internal customers and external regulators to maintain compliance and data quality in a fast-paced health plan environment.

Qualifications

• 2+ years of HEDIS medical record review experience, including over-read responsibilities.
• 2 years of training or overseeing staff.
• 3+ years in a clinical, health plan or health information management environment.
• HS Diploma or GED required.
• Preferred: Bachelor's in business, public health, nursing or related field.
• Preferred: healthcare license (RN/LPN/LVN) or similar credential.

Responsibilities

• Lead design, piloting, and monitoring of HEDIS/Stars projects and oversee implementation.
• Develop policies, procedures, and training materials; deliver training.
• Validate supplemental data sources and perform primary source verification.
• Maintain subject matter expertise on HEDIS measures, data in the legal health record, and new medical technologies.
• Manage audits and compliance deliverables; track timelines and outcomes.
• Onboard and develop abstraction/retrieval staff; coordinate with internal/external stakeholders.

Skills

HEDIS knowledge

Staff training

Clinical experience

Quality improvement

Communication

Education

HS Diploma or GED

Bachelor's degree

Healthcare license (RN/LVN/LPN)

Tools

Microsoft Teams

Outlook

Excel

EMR/HIE

Job description

Blue Cross Blue Shield of Arizona is seeking a qualified professional to lead NCQA HEDIS data retrieval, review, and overread initiatives. You will design, pilot, and monitor projects, and ensure timely reporting and remediation of gaps. This is a full-time, hybrid role based in Arizona.

You will train staff, manage data sources, and coordinate with internal customers and external regulators to maintain compliance and data quality in a fast-paced health plan environment.