Senior HEDIS Lead & Training Strategist

Blue Cross Blue Shield of AZ; Phoenix (AZ); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Hybrid work schedule

Job summary

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

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
• External customers include accreditation and regulatory organizations, peer review organizations, payers, patients, healthcare providers, clinical registries, and databases.

Skills

HEDIS expertise

Training staff

Project management

Clinical environment

Data retrieval

Education

HS Diploma

Bachelor's degree

Tools

HEDIS software

Health IT systems

Job description

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