Your Role

The Clinical Quality Measurement team manages HEDIS annual submissions and other quality measure submissions to CMS, NCQA, DHCS and other governing bodies. The Medical Informatics Analyst, Consultant will report to the Sr Manager, Medical Informatics. In this role You will support corporate and departmental strategies and goals for the annual HEDIS submission process and effectively apply business knowledge and technical expertise to support the business initiatives to report clinical quality of care received by members. You will collect data from various internal systems (examples: Claims processing or membership systems) and external systems (EMR/EHR) and convert those data into actionable insights to guide business decision making for BSC population health management and quality of care. You will also support lower level analysts on programming and business knowledge acquisition.

Your Work

In this role, you will:

• Conduct independent analysis of high complexity and develops reports independently Develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels
• Communicate analytical results in graphs or summaries to various stakeholders.
• Develop documentation and create and execute workplans for analyses of high complexity.
• Prepare presentation materials that clearly convey information to appropriate internal and external Blue Shield audiences
• Provide training and mentoring for team members on best practices for analysis and Reporting
• Review and revise existing analytical processes for accuracy and efficiency. Identify existing inefficiencies and problems and take action to implement solutions
• Continuously refine and expand the technical, clinical, and financial content knowledge required to successfully complete these duties
• Develop, implement, and document quality assurance (QA) processes to ensure that reported data is accurate and reliable
• Recommend and implement solutions for identified problems/root cause pertaining to clinical data used for HEDIS reporting
• Assist junior team members through peer review, informal training, or mentoring
• Contribute to team success by accomplishing tasks as needed