Job Description

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.

This 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 medical record review (MRR) and overread.

REQUIRED QUALIFICATIONS

Required Work Experience

  • 2 years/seasons of HEDIS medical record review experience, with at least one season of over-read responsibilities.
  • 3 years’ experience in a clinical, health plan or health information management environment

Required Education

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

Required Licenses

  • None

Required Certifications

  • None

PREFERRED QUALIFICATIONS

Preferred Work Experience

  • None

Preferred Education

  • Bachelor's degree in business, public health, nursing, or related area

Preferred Licenses

  • Active or inactive license in any state or territory of the United States as a Licensed Vocational Nurse, Licensed Practical Nurse, Registered Nurse or similar license

Preferred Certifications

  • Active or inactive certification as a medical coder or similar credential in health information management

ESSENTIAL JOB FUNCTIONS AND REPONSIBILITIES

  • Supports the monitoring of various HEDIS/Stars projects; oversees implementation as assigned.
  • Contributes to policies, procedures, and training materials.
  • Maintains 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 corrects personal and vendor accuracy and productivity issues.
  • Coordinates MRR and related HEDIS compliance audit deliverables,
  • Internal 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 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 COMPETENCIES

Required Job Skills

  • Managing small-scale projects--independently setting timelines, coordinating, monitoring, troubleshooting, summarizing, and reporting on project deliverables
  • Independently troubleshoots basic desktop/login issues, using the Help Desk if needed
  • Advanced proficiency with a variety of software applications and/or vendor tools that are used to manage and/or conduct HEDIS activities
  • Software 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 English
  • Thrives in a paperless environment
  • Manages time and productivity-independently planning, escalations and troubleshooting to ensure deadlines are met
  • Anticipates and shifts to new tasks frequently as priorities emerge
  • Works on projects whose timelines overlap
  • Excellent personal organizational skills, including note taking, to eliminate unnecessary rework
  • Creates and utilizes checklists and other quality checks to ensure work is accurate, complete and of high quality
  • Proficiency with a variety of software applications and/or vendor tools used to manage and/or conduct HEDIS project
  • Working knowledge of NCQA’s HEDIS Compliance Audit deliverables and process

Analytical knowledge and skills to evaluate and make decisions based on available information

Required Professional Competencies

  • Independently manages assignments, time and priorities
  • Collaborates and communicates transparently with leadership and coworkers, openness to feedback
  • Interprets and applies policies, procedures, performance measure specifications and different measurement methodologies
  • Interprets and implements HEDIS or similar technical specifications at an intermediate level; ability to update knowledge when specifications change
  • Confirms to all established policies, procedures and regulations in maintaining confidentiality and privacy
  • Exercises independent and sound judgment with good problem-solving skills
  • Manages multiple tasks simultaneously in a demanding, fast-paced environment while keeping relevant others in the organization informed of progress
  • Successfully 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 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
  • Accountability for long- and short-term multi-faceted projects

Required Leadership Experience and Competencies

  • N/A

PREFERRED COMPETENCIES

Preferred Job Skills

  • N/A

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.

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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