FEP HEDIS Coordinator - Hybrid
Job Description
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.
This position is Hybrid within the state of AZ only. This hbrid work opportunity requires residency, and work to be performed, within the State of Arizona.
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
REQUIRED QUALIFICATIONS
Required Work Experience
- 2 years of HEDIS® experience including analytics
- 1 year of quality improvement experience
- 1 year experience in analytics
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
- 1 year(s) of experience in health insurance, or other health care related field
- Project experience
- Clinical experience / background
Preferred Education
- Bachelor’s degree in business, Analytics or related field
- Associate’s degree in nursing or healthcare field
Preferred Licenses
- N/A
Preferred Certifications
- N/A
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 postmortem 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
- 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
LEAD
- Ability to perform the essential job functions outlined above.
- Coordinate completion of FEP HEDIS® roadmap in conjunction with FEP initiatives and mandates
- Develop and respond to FEP HEDIS Audit Corrective Action Plan (CAP) as necessary
- Develop and maintain the FEP HEDIS training manual and documentation in accordance with department standards, including industry best practices
- Development of work plan and tracking of the FEP HEDIS quality improvement Intervention Measures
- Develop and respond to the FEP yearly business plan
- Develop and implement key HEDIS initiatives/activities through collaboration/coordination with the FEP Field Service Team
REQUIRED COMPETENCIES
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),
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
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
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.
Preferred Professional Competencies
- Knowledge of a variety of software applications to manage HEDIS® project
Preferred Leadership Experience and Competencies
- N/A
Our Commitment
AZ 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.
Application Instructions
Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!
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