Lead HEDIS Specialist - Hybrid

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 weekHybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per weekHybrid 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 monthOnsite: daily onsite requirement based on the essential functions of the jobRemote: 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 buildingPlease 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 JOBThis 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 QUALIFICATIONSRequired Work Experience2 years/seasons of HEDIS medical record review experience, with at least one season of over-read responsibilities.2 years of training or overseeing staff3 years’ experience in a clinical, health plan or health information management environmentRequired EducationHigh-School Diploma or GED in general field of studyRequired LicensesNoneRequired CertificationsNonePREFERRED QUALIFICATIONSPreferred Work Experience5 years’ experience in a clinical and/or health plan environmentPreferred EducationBachelor's degree in business, public health, nursing, or related areaPreferred LicensesActive or inactive license in any state or territory of the United States as a Licensed Vocational Nurse, Licensed Practical Nurse, Registered Nurse, or similar licensePreferred CertificationsCertified coder or similar credential in health information managementCertified in healthcare quality or project managementESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIESSupports 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 staffInternal 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 COMPETENCIESRequired Job SkillsManages projects-independently sets timelines, coordinates, monitors, troubleshoots, summarizes, and reports on project deliverablesIndependently troubleshoots basic desktop/login issues, using the Help Desk if neededAdvanced proficiency with a variety of software applications and/or vendor tools that are used to manage and/or conduct HEDIS activitiesSoftware proficiencies—basic Microsoft Teams and email and Outlook calendar skills; basic Excel skills, including filter and sort; highlight, mark up and remove pages from pdfs; file management in OneDrive/Windows Explorer, electronic medical records (EMR), electronic disease registries and/or health information exchanges (HIE)Familiarity with the legal health record, its contents, search techniques, EMR, HIE, and clinical registries (i.e., immunization registry); ability to interpret and communicate regarding this clinical information in EnglishThrives in a paperless environmentManages time and productivity—independently planning, escalations and troubleshooting to ensure deadlines are metAnticipates and shifts to new tasks frequently as priorities emergeWorks on projects whose timelines overlapExcellent personal organizational skills, including note taking, to eliminate unnecessary reworkCreates and utilizes checklists and other quality checks to ensure work is accurate, complete and of high qualityProficiency with a variety of software applications and/or vendor tools used to manage and/or conduct HEDIS projectWorking knowledge of NCQA’s HEDIS Compliance Audit deliverables and processAnalytical knowledge and skills to evaluate and make decisions based on available informationundefinedRequired Professional CompetenciesIndependently manages assignments, time, and prioritiesCollaborates and communicates transparently with leadership and coworkers, openness to feedbackInterprets and applies policies, procedures, performance measure specifications and different measurement methodologiesInterprets and implements HEDIS or similar technical specifications at an intermediate level; ability to update knowledge when specifications changeConfirms to all established policies, procedures, and regulations in maintaining confidentiality and privacyExercises independent and sound judgment with good problem-solving skillsManages multiple tasks simultaneously in a demanding, fast-paced environment while keeping relevant others in the organization informed of progressSuccessfully works with minimal supervision, seeks out and seizes opportunities, finds ways to surmount barriers, and takes lead roles in working with key stakeholders and other analystsShares important and relevant information with the team. Proactively offers suggestions, provides resources, volunteers for assignments, and removes barriers to help the team accomplish its goalsAccountability for long- and short-term multi-faceted projectsRequired Leadership Experience and CompetenciesSuperior ability to effectively engage various audiences under a variety of fast-paced and high-profile circumstances, orally and in writingExperience communicating with a high level of discretion and professionalism with physician leaders/office staff, executives, and other stakeholdersAbility to independently manage technical/complex, multi-staged projects from beginning to endPREFERRED COMPETENCIESPreferred Job SkillsN/APreferred Professional CompetenciesOutreach and other improvement initiative skillsPreferred Leadership Experience and CompetenciesSuccessful experience as a team leader or supervisor#LI-AB1Our CommitmentAZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply. #J-18808-Ljbffr Blue Cross Blue Shield of Arizona