Hedis Quality Improvement Data Analyst

Awarded the Best Place to Work 2021, 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.
This position is remote within the state of AZ only. This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
Purpose of the job
The HEDIS/Quality Improvement Data Analyst's main focus will be providing analytical expertise and operational support to the HEDIS/Star Programs and data QA and reporting. This position will be responsible for identifying and quantifying key drivers, investigating areas of opportunity, evaluating effectiveness and making recommendations. The incumbent will be relied upon to apply business knowledge to analytics projects and provide value-added insights to impact business outcomes.
REQUIRED QUALIFICATIONS
Required Work Experience

• 2 years of experience managing healthcare analytics-based data sets in a hospital of insurance plan environment.

Required Education

• High-School Diploma or GED in general field of study.

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS
Preferred Work Experience

• 3 years managing healthcare-based data sets.
• 2 years of experience in working with any claims processing application is preferred.
• 2 years of experience with EMR packages like EPIC, Cerner, Centricity.
• 2 years of experience working with data visualization tools such as Qlik, SSAS, or Tableau.
• 5 years of experience with HEDIS and Medicare Star Part C & D programs, methodology, and analytics.

Preferred Education

• Background or corresponding degree in biostatistics, healthcare administration, or nursing.

Preferred Licenses

• N/A

Preferred Certifications

• Professional certification in a healthcare, such as CPHQ

ESSENTIAL job functions AND RESPONSIBILITIES

• Designs and produces timely and meaningful analysis and data interpretation on large healthcare datasets, related to:
  • HEDIS operations, all lines of business
  • Medicare STAR Program
  • Performance Improvement Projects
• Collaborates with Medicare and Medicaid Performance team to advance specific programs (such as QIP/PIP), programs issued by state agencies (such as DHCS or HSAG) and other associated company initiatives.
• Utilizes software programs such as MS Access, Excel and other business intelligence tools to extract, analyze and report data. Creates and modifies code/formulas/queries, as needed to execute projects to specifications, and assists in the development of these
• Interprets data accurately and produces clear and comprehensive written analyses, visualizations, tables, etc. for diverse internal and external audiences.
• Plans, organizes, and prioritizes assigned projects, creating and managing work plans that reflect the tasks, timeframes, and processes required to successfully complete each.
• Supports data collection (including medical records), qualitative and quantitative analysis and transformation into information that can be reported to committees/work groups to identify opportunities for improvement
• Supports HEDIS and Star performance workgroup activities, operations, and special projects as needed.
• Monitors quality program compliance with regulatory requirements for CMS, NCQA, HHSC, TDI and other agencies. Participates in the review and analysis of data from survey tools, including but not limited to, provider satisfaction surveys and CAHPS surveys.
• 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.

competencies
REQUIRED COMPETENCIES
Required Job Skills

• Experience with HEDIS and Medicare Part C & D Star Program analytics, or similar metrics (e.g., ECDS, SAMHSA's NOM, Medicaid Core, PQA)
• Advanced skills and experience in database management, Access, Excel, (Pivot tables, V lookup, H lookup, conditional formatting).
• Experience managing healthcare analytics-based data sets in a managed care or hospital environment
• Intermediate experience with Microsoft Word and other MS Office Suite applications.

Required Professional Competencies

• Excellent time/project management skills, ability to work independently and meet deadlines/expectations; providing management with status updates and dashboards pertinent to HEDIS/STARs and quality and performance improvement programs for providers.
• Ability to present comprehensive analytic results orally and in writing to medical offices, plans, and providers incorporating measure descriptions, relevant data, and other background material to provide context for results.
• Ability to understand and accurately communicate complex regulatory and technical documents (e.g., regulations, contracts, performance measure technical specifications) to a variety of internal and external audiences. Public speaking and group presentation skills required.
• Self-starter, resourceful and able to execute projects in a fluid and fast paced environment.
• Ability to quickly learn and effectively use various software programs such as claims systems, QuickBase, and EMRs

Required Leadership Experience and Competencies

• N/A

PREFERRED COMPETENCIES
Preferred Job Skills

• Advanced using data analysis software (i.e., SAS, SPSS, SQL, Python, R, etc.)
• Experience with working data visualization tools such as Qlik, SSAS or Tableau.

Preferred Professional Competencies

• N/A

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 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.