HEDIS Data Operations Mgr
Phoenix, AZ 
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Job Description
Job Details
Job Title
HEDIS Data Operations Mgr
Job ID
6198
Location
Phoenix
Full/Part Time
Full-Time
Favorite Job
Regular/Temporary
Regular
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
This position provides consultation and support in the development, acquisition, analysis, interpretation, and management of a variety of highly complex data sources. Acts as a content expert for data and analytics supporting the HEDIS and CMS Star performance improvement, operations, strategy, and increased patient safety and satisfaction initiatives.

Essential Job Functions & Responsibilities
* The HEDIS Data Operations Manager will be responsible for discovering information hidden in vast amounts of data through design, development and implementation of optimal analytical solutions. The HEDIS Data Operations Manager will be responsible for all roles related to HEDIS and CMS Star/regulatory data development, acquisition, automation, analysis, evaluation; data submissions - oversight of data to/from HEDIS/CAHPS and performance-related vendors ensuring accuracy and completeness; tracking of all data packages & load reports, and trouble-shooting issues as needed.
* The incumbent is responsible for supporting the business goals and objectives for health outcomes and quality related to HEDIS, CMS Stars and other CMS/state regulatory quality and performance initiatives as they emerge due to our growth. This position will work within the HEDIS/Stars team of the Medicare & Medicaid Performance department and will collaborate with several teams/departments across the organization.
* Subject matter expertise in HEDIS, CMS Stars, Medicaid Core, PQA, NOM, HOS, CAHPS and other performance measure technical specifications, data collection, measurement, and data optimization strategies; Leads and participates in interactions with regulators and auditors related to data/reporting as assigned;
* Design & Development, providing technical development expertise for designing, coding, testing, debugging, documenting, and supporting analytical applications consistent with the established specifications and business requirements for the HEDIS/Star team to deliver business value; Maintains accurate, thorough, user-friendly written guides, desktop procedures, and policies on a variety of data-related topics;
* System Integration, integrating software components, subsystems, facilities and services data into the existing technical systems environment; assessing impact on other systems, and working with cross-functional teams to ensure positive project impact;
* System Management, participating in development of standards, designing and implementing proactive processes to collect and report data supporting the HEDIS/Star team's operations & performance improvement initiatives; collaborating with QI Analyst/Senior Manager to ensure development and automation of high quality data visualizations supporting HEDIS and Stars/performance metrics.
* The position 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.
* Perform all other duties as assigned.

Employment Requirements


Required Qualifications
1. Required Skills & Work Experience
* 3 years of SQL server experience including database management, ETL, data modeling, data warehousing, and reporting;
* 3 years business intelligence tools (e.g., Power BI, Tableau, Qlik Sense), and reporting via dashboards and scorecards;
* 3 years of experience using HEDIS/CMS performance measures, analyzing and interpreting underlying data and summary rates, identifying gaps and opportunities in trends in member-level data, acquiring new data sources, and regulatory reporting for a managed care/health plan organization; and
* 3 years of experience in planning, participating, and managing technical/complex multi-faceted projects from beginning to end.
2. Required Education
* Bachelor's Degree in Health Informatics, Analytics, Computer Science or a related discipline
3. Required Licenses
* N/A
4. Required Certifications
* N/A


Preferred Qualifications
1. Preferred Work Experience
* 5 years of SQL server experience including database management, ETL, data modeling, data warehousing, and reporting;
* 5 years business intelligence tools (e.g., Power BI, Tableau, Qlik Sense), and reporting through dashboards and scorecards;
* Current knowledge of NCQA HEDIS Supplemental and Administrative data processes and source requirements;
* 5 years of experience using HEDIS/CMS performance measures, analyzing and interpreting underlying data and summary rates, identifying gaps and opportunities in trends in member-level data, acquiring new data sources, and regulatory reporting for a managed care/health plan organization; and,
* 5 years of experience in planning, participating, and managing technical/complex multi-faceted projects from beginning to end.
2. Preferred Education
* Master's Degree in Health Informatics, Analytics, Computer Science or a related discipline
3. Preferred Licenses
* Past or present clinical licensure
4. Preferred Certifications
* Clinical, medical coding, health informatics or related certification


Required Competencies

REQUIRED COMPETENCIES
1. Required Job Skills
* Current knowledge of NCQA HEDIS Supplemental and Administrative data processes and source requirements;
* Demonstrates intermediate-level SQL skills;
* Reviews and evaluates data & analyses for validity, accuracy, completeness, appropriateness of model selection, limitations and valid interpretation of results;
* Demonstrates technical proficiency with healthcare performance measures and member-level data including HEDIS, Medicare Stars, Pharmacy Quality Alliance (PQA) and Medicaid Core measures;
* Advanced understanding of CMS regulations, methodologies and deliverables & familiarity with AHCCCS regulations, methodologies, and deliverables;
* Collaborates with internal resources to design, create, test, and implement analytic tools (reports, dashboards, etc.) that support the HEDIS/Stars initiatives and that improve data collection and reporting strategies (minimize duplication, redundancy, etc.);
* Superior ability to quickly learn & understand, translate, and operationalize complex regulatory, contractual, technical, and clinical languages/terminology;
* Ability to bridge clinical and technical information to a variety of audiences & drive communication of action plans to meet business needs.
2. Required Professional Competencies
* Exudes excellence by setting high standards of performance for self and all coworkers, demonstrates low tolerance for mediocrity, requires high-quality results and exhibits conscientiousness and high sense of responsibility;
* Stimulates creativity with the ability to see broadly outside the typical status quo and is constantly open to and promotes new ideas;
* Excellent trouble-shooting, analytic and problem-solving skills with the ability to create and communicate effective solutions;
* Ability to manage multiple tasks simultaneously in a demanding, fast-paced environment while keeping relevant others in the organization informed of progress;
* Ability to successfully work with minimal supervision, seeks out and seizes opportunities, finds ways to surmount barriers, and takes lead roles in working with key stakeholders and other analysts;
* Shares important and relevant information with the team. Proactively offers suggestions, provides resources, volunteers for assignments, and removes barriers to help the team accomplish its goals.
3. Required Leadership Experience and Competencies
* Superior ability to effectively engage various audiences under a variety of fast-paced and high profile circumstances, orally and in writing;
* Experience communicating with a high level of discretion and professionalism with regulators, auditors, providers, regulators, vendors, executives and other stakeholders;
* Ability to independently manage technical/complex, multi-staged projects from beginning to end.


Preferred Competencies
1. Preferred Job Skills
* N/A
2. Preferred Professional Competencies
* Successful experience designing, developing and implementing integrated data/analytical systems for new health plans/lines of business;
* Successful experience maximizing data capture with various network infrastructures, i.e., integrated medical-behavioral health providers, ACO, FQHC, mobile health;
* Successful experience simultaneously managing multiple governmental lines of business.
3. Preferred Leadership Experience and Competencies
* N/A

Our Commitment

Within BCBSAZ and HCA, it is essential that we create a culture of inclusion and opportunity as well as actively guard against bias of any kind. Discrimination and racism are real. Our aim is to empower every member of our team to engage in our mission of improving health for Arizonans. We believe that the power and perspective of diversity and inclusion is in fact, essential to our success in serving clients, achieving our mission and creating a healthy environment for all.

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.


Our Commitment


Blue Cross Blue Shield of Arizona does not discriminate in hiring or employment on the basis of race, ethnicity, religion, national origin, sexual orientation, gender, disability, age, protected veteran status or any other protected group.

 

Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
3+ years
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