Lead HEDIS Specialist - Medical Record Review

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 remote work opportunity requires residency, and work to be performed, within the State of Arizona. PURPOSE OF THE JOB 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 leading all aspects of training, implementation and reporting of medical record retrieval, review (MRR) and overread. QUALIFICATIONS REQUIRED QUALIFICATIONS Required Work Experience 2 years/seasons of HEDIS medical record review experience, with at least one season of over-read responsibilities. 2 years of training or overseeing staff 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 5 years’ experience in a clinical and/or health plan environment 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 Certified coder or similar credential in health information management Certified in healthcare quality or project management ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES Supports the design, piloting, and monitoring of various HEDIS/Stars projects; oversees implementation as assigned. Develops policies, procedures, and training materials; delivers training. Initiates and project manage the validation of supplemental data sources (“primary source verification”). Ensures self and team maintain 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 addresses accuracy and productivity issues. Leads MRR and related HEDIS compliance audit deliverables, Oversees and performs project management of assignments from beginning to end establishing timelines, coordinating, monitoring, troubleshooting, summarizing, and reporting on project deliverables. Observes, tracks and reports opportunities for improvement and effective practices. Onboards new abstraction/retrieval staff 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. COMPETENCIES REQUIRED COMPETENCIES Required Job Skills Manages projects--independently sets timelines, coordinates, monitors, troubleshoots, summarizes, and reports 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 Superior ability to effectively engage various audiences under a variety of fast-paced and high-profile circumstances, orally and in writing Experience communicating with a high level of discretion and professionalism with physician leaders/office staff, executives, and other stakeholders Ability to independently manage technical/complex, multi-staged projects from beginning to end PREFERRED COMPETENCIES Preferred Job Skills N/A Preferred Professional Competencies Outreach and other improvement initiative skills Preferred Leadership Experience and Competencies Successful experience as a team leader or supervisor CORPORATE RESPONSIBILITIES 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. 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.