Lead HEDIS Specialist - Hybrid

Blue Cross Blue Shield of AZ; Phoenix (AZ); Hybride; USD 70 000 - 95 000; Plein temps

Avantages offerts par ce poste

Hybrid work schedule

Résumé du poste

Blue Cross Blue Shield of AZ is seeking a detailed and collaborative HEDIS Abstraction/Review professional to lead and implement Healthcare Effectiveness Data and Information Set initiatives. You will oversee training, validation of data sources, and ensure team accuracy while maintaining expertise on medical technologies and records.

The role requires onsite and hybrid work within Arizona. Responsibilities include leading MRR and HEDIS audits, onboarding staff, and coordinating cross-functional

Qualifications

• 2 years/seasons of HEDIS medical record review experience, with at least one season of over-read responsibilities.
• 2 years of training or overseeing staff
• 3 years' experience in a clinical, health plan or health information management environment
• High-School Diploma or GED in general field of study

Responsabilités

• Supports the design, piloting, and monitoring of various HEDIS/Stars projects; oversees implementation as assigned.
• Develops policies, procedures, and training materials; delivers training.
• Initiates and project manage the validation of supplemental data sources ("primary source verification").
• Ensures self and team maintain subject matter expertise on all means to close HEDIS gaps and exclusions, new medical technologies, medications and how to find this data in the legal health record.
• Monitors and addresses accuracy and productivity issues.
• Leads MRR and related HEDIS compliance audit deliverables,
• Oversees and performs project management of assignments from beginning to end establishing timelines, coordinating, monitoring, troubleshooting, summarizing, and reporting on project deliverables. Observes, tracks and reports opportunities for improvement and effective practices.
• Onboards new abstraction/retrieval staff
• External customers include accreditation and regulatory organizations, peer review organizations, payers, patients, healthcare providers, clinical registries, and databases.

Connaissances

HEDIS expertise

Training staff

Project management

Clinical environment

Data retrieval

Formation

HS Diploma

Bachelor's degree

Outils

HEDIS software

Health IT systems

Description du poste

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
• Onsite: daily onsite requirement based on the essential functions of the job
• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB

This position is responsible for National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set's (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) initiatives, including leading all aspects of training, implementation and reporting of medical record retrieval, review (MRR) and overread.

REQUIRED QUALIFICATIONS

• Required Work Experience
  • 2 years/seasons of HEDIS medical record review experience, with at least one season of over-read responsibilities.
  • 2 years of training or overseeing staff
  • 3 years' experience in a clinical, health plan or health information management environment
• Required Education
  • High-School Diploma or GED in general field of study
• Required Licenses
  • None
• Required Certifications
  • None

PREFERRED QUALIFICATIONS

• Preferred Work Experience
  • 5 years' experience in a clinical and/or health plan environment
• Preferred Education
  • Bachelor's degree in business, public health, nursing, or related area
• Preferred Licenses
  • Active or inactive license in any state or territory of the United States as a Licensed Vocational Nurse, Licensed Practical Nurse, Registered Nurse, or similar license
• Preferred Certifications
  • Certified coder or similar credential in health information management
  • Certified in healthcare quality or project management

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Supports the design, piloting, and monitoring of various HEDIS/Stars projects; oversees implementation as assigned.
• Develops policies, procedures, and training materials; delivers training.
• Initiates and project manage the validation of supplemental data sources ("primary source verification").
• Ensures self and team maintain subject matter expertise on all means to close HEDIS gaps and exclusions, new medical technologies, medications and how to find this data in the legal health record.
• Monitors and addresses accuracy and productivity issues.
• Leads MRR and related HEDIS compliance audit deliverables,
• Oversees and performs project management of assignments from beginning to end establishing timelines, coordinating, monitoring, troubleshooting, summarizing, and reporting on project deliverables. Observes, tracks and reports opportunities for improvement and effective practices.
• Onboards new abstraction/retrieval staff
• Internal customers include corporate administrators, management team and staff.
• External customers include accreditation and regulatory organizations, peer review organizations, payers, patients, healthcare providers, clinical registries, and databases.
• The position has an onsite expectation of 1 day per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Performs all other duties as assigned.

REQUIRED COMPETENCIES

Required Job Skills

• Manages projects--independently sets timelines, coordinates, monitors, troubleshoots, summaries, and reports on project deliverables
• Independently troubleshoots basic desktop/login issues, using the Help Desk if needed
• Advanced proficiency with a variety of software applications and/or vendor tools that are used to manage and/or conduct HEDIS ac