Introduction
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.
Position Details
Purpose of the Job
Coordination of the Healthcare Effectiveness Data and Information Set (HEDIS) Audit, roadmap preparation, data collection and reporting processes in addition to HEDIS intervention activities to improve related clinical performance measures for the FEP lines of business. Additionally, this position will take a lead role in coordinating the efforts to improve and is responsible for coordination activities related to the HEDIS measures for FEP. Serves as the liaison with Network Management, Health Services, Finance, Informatics, Federal Employee Program (FEP) and other ad hoc departments and programs as necessary
Essential Job Functions & Responsibilities
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
* Provide timely FEP HEDIS measure status reporting, including trending and analyzing of the data
* Development and execution of FEP HEDIS intervention steps to improve targeted measures
* Participate in the FEP HEDIS post mortem analysis to increase rates and evaluate and analyze annual FEP HEDIS rates
* Define objectives, processing requirements and specifications to document steps taken and results achieved related to HEDIS results
* Assist in coordinating new enhancements, including system enhancements and report generation, to improve FEP HEDIS scores
* Create ad-hoc reports to assist with the tracking of the FEP HEDIS measures
* Interpret, communicate and present results in a consistent and easy to understand format that facilitates fact-based decision making
* Display initiative in researching beyond the specific assignment
* Along with research, create analyses and recommendations that will allow FEP to meet the HEDIS goals
* Incorporate strategic planning and then breaking down high-level project information into manageable components to define and forecast work components
* Participate and/or coordinate projects with the HEDIS interdepartmental team, building and maintain a good working relationship with internal and external stakeholders and key contacts
* Demonstrate and maintain current working knowledge of the required BCBSAZ systems
* Maintain all standards in consideration of State, Federal, FEP, BCBSAZ and other applicable regulatory/accrediting agency requirements as they apply to department functions
Employment Requirements
Required Qualifications
1. Required Work Experience
* 2 years of HEDIS experience including analytics
* 1 year of quality improvement experience
* 1 year experience in analytics
2. Required Education
* High-School Diploma or GED in general field of study
3. Required Licenses
* N/A
4. Required Certifications
* N/A
Preferred Qualifications
1. Preferred Work Experience
* 1 year(s) of experience in health insurance, or other health care related field
* Project experience
* Clinical experience / background
2. Preferred Education
* Bachelor's degree in Business, Analytics or related field
* Associate's degree in nursing or healthcare field
3. Preferred Licenses
* N/A
4. Preferred Certifications
* N/A
Required Competencies
1. Required Job Skills
* Strong organizational skills
* Strong written and verbal communications
* Knowledge of NCQA HEDIS regulations including roadmap development and accreditation standards.
* Project management skills and improvement development
* Advanced Proficiency with Microsoft office suite applications (Outlook, Access, Excel),
2. Required Professional Competencies
* Strong analytical skills necessary to generate and implement sound solutions
* Interpret results of implemented practices, analyzing impacts and recommending solutions
* Practice interpersonal and active listening skills to achieve customer satisfaction and departmental communication standards
* Interpret and translate policies, procedures, programs and guidelines
* Establish and maintain working relationships in a collaborative team environment
* Independent and sound judgment with good problem solving skills
* Maintain confidentiality and privacy
3. Required Leadership Experience and Competencies
* Ability to define project scope, identify priorities and implement solutions
* Ability to work in a partnership setting
* Demonstrate effective presentation skills
Preferred Competencies
1. Preferred Job Skills
* Knowledge of HEDIS project management
* Advanced management of HEDIS audit roadmap development and implementation
* Advanced knowledge of information systems including Microsoft office suite plus public and proprietary software applications
* Advanced knowledge of CPT-4, HCPCS, ICD-9 and ICD-10 coding
* Ability to effectively communicate with Providers, Vendors and other external and internal customers.
2. Preferred Professional Competencies
* Knowledge of a variety of software applications to manage HEDIS project
3. Preferred Leadership Experience and Competencies
* N/A
Our Commitment
BCBSAZ 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
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.
