Quality Improvement Liaison (Federal Employee Program, remote)
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.
Provide strategic analysis and operational support that impacts business decisions, improves efficiency and drives innovation for the Federal Employee Program (FEP) Quality Improvement Team. Perform data extraction, data analysis, as well as production of various reports to support quality improvement strategies and initiatives. Additionally, this position will take a supporting role in coordinating the improvement efforts and is responsible for coordination activities related to HEDIS and CAHPS measures for FEP. In conjunction with the Quality Improvement Coordinators, will serve as the liaison with Network Management, Health Services, Finance, Informatics, Federal Employee Program Director’s Office (FEPDO) and other ad hoc departments and programs as necessary.
Required Work Experience
- 1 year of experience working in healthcare analytics-based data sets in a hospital or insurance plan environment.3 years of experience in healthcare industry and / or year of quality improvement experience
- High-School Diploma or GED in general field of study.
Preferred Work Experience
- 4 years of experience in healthcare industry
- 2 years of quality improvement experience, including HEDIS®, Population Health, CMS Shared Savings, Accountable Care Organization, or STARS
- 3 years of experience working in healthcare analytics-based data sets in a hospital or insurance plan environment.
- Associate Degree in general field of study
ESSENTIAL job functions AND RESPONSIBILITIES
- Works in a team setting with FEP quality improvement peers to make sound assumptions and fact-based recommendations, and facilitate fact-based decision-making
- Tracks the impact of all implemented projects and asses their effectiveness
- Researches, documents, and resolves all data related inquiries received from either internal or external customers
- Analyzes data output and recommends changes and enhancements to existing reporting, business, procedures and business rules
- Serve as main point of contact for internal BCBSAZ stakeholders, FEPDO contacts, and external providers or vendors related to FEP quality data and related tools
- Suggest alternative methods and procedures in solving problems and meeting changing measurement and data needs.
- Analyze reports and data for aberrancies, reasonability and accuracy and provide recommendation for problem resolution to management.
- Create and modify code/formulas/queries, as needed to execute projects to specifications, and assists in the development of projects and initiatives
- Interpret data accurately and produce clear and comprehensive written analyses, visualizations, tables, etc. for diverse internal and external audience
- Participate in the FEP QCR post mortem analysis to increase rates and evaluate and analyze annual FEP Quality, Customer Service, and Resource Use (QCR) rates
- Actively demonstrates superior customer service to all internal and external contacts.
- Utilize compassionate listening, research, problem solving and documentation of Member complaints and concerns that are identified through CTM and other Member touch points
- Works cross-functionally with internal and external teams to ensure retention program outcomes and member satisfaction goals are met
- May represent the health plan at external events, health fairs, new member orientations and other plan educational events
- Conducts outbound call campaigns, surveys and other member focused interventions utilizing outbound call scripts and talking points
- Reads and responds to department communications, actively participates in staff meetings and department activities that include process improvements or team building
- 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.
- May require some state-wide and out of state travel
Required Job Skills
- Advanced skills and experience in database management, Access, Excel, (Pivot tables, V lookup, H lookup, conditional formatting).
- Intermediate experience with Microsoft Word and other MS Office Suite applications.
Required Professional Competencies
- Ability to work independently and meet deadlines/expectations
- Ability to present comprehensive analytic results orally to all stakeholders, incorporating measure descriptions, relevant data, and other background material to provide context for results.
- 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, Cognizant, and A2.0
Required Leadership Experience and Competencies
Preferred Job Skills
- Knowledge of HEDIS data and NCQA HEDIS Data Specifications
- Advanced proficiency in spreadsheet, database and word processing software
- Intermediate proficiency with data warehouses and query tools / design
- Intermediate skill with data visualization tools, such as Tableau
- Advanced skill in database, spreadsheet, business intelligence, statistical, and data cubing software
- Knowledge of health benefit design and rating techniques
- Advanced skills in mathematics and statistics
Preferred Professional Competencies
Preferred Leadership Experience and Competencies
Comply with BCBSAZ corporate and departmental policies and procedures, including, but not limited to Code Blue, Compliance, HIPAA, Computer Responsibility, Accreditation Standards, Attendance, Staff Qualifications, and Quality Management Accountabilities.
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.