Lead HEDIS Specialist - Hybrid

Blue Cross Blue Shield of Arizona•Phoenix, AZ

12d•Hybrid

About The Position

This position leads Blue Cross Blue Shield of Arizona’s HEDIS initiatives, including training, implementation, and reporting for medical record retrieval and review (MRR) and overread. The role supports HEDIS/Stars projects, develops policies and training materials, validates supplemental data sources, maintains expertise in methods for closing HEDIS gaps, and monitors quality and productivity. It also leads MRR and HEDIS compliance audit deliverables and manages projects from planning through reporting. The position is hybrid within Arizona, with an onsite expectation of one day per week. It requires a full-time schedule of at least 40 hours per week, plus additional hours as requested or needed to meet business requirements. The role works with internal administrators, managers, and staff, as well as external accreditation and regulatory organizations, peer review organizations, payers, patients, healthcare providers, clinical registries, and databases.

Requirements

High school diploma or GED.
At least 2 years or seasons of HEDIS medical record review experience, including at least one season with overread responsibilities.
At least 2 years of experience training or overseeing staff.
At least 3 years of experience in a clinical, health plan, or health information management environment.
Ability to independently manage projects, set timelines, coordinate work, monitor progress, troubleshoot, and report deliverables.
Advanced proficiency with software applications and vendor tools used to manage or conduct HEDIS activities.
Basic proficiency with Microsoft Teams, email and Outlook calendar, and Excel functions including filtering and sorting; ability to mark up PDFs, remove pages, and manage files in OneDrive/Windows Explorer.
Familiarity with legal health records, EMRs, HIEs, clinical registries, and techniques for searching and interpreting clinical information; ability to communicate about that information in English.
Ability to work effectively in a paperless environment and independently manage time, productivity, changing priorities, overlapping project timelines, and deadlines.
Strong organization and quality-control skills, including note-taking and use of checklists.
Working knowledge of NCQA HEDIS Compliance Audit deliverables and processes.
Analytical skills to evaluate available information and make decisions.
Ability to interpret and apply policies, procedures, performance measure specifications, and measurement methodologies; ability to implement HEDIS or similar technical specifications at an intermediate level and update knowledge as they change.
Ability to maintain confidentiality and privacy in accordance with policies, procedures, and regulations.
Sound judgment and problem-solving skills; ability to manage multiple tasks in a demanding, fast-paced environment with minimal supervision.
Ability to collaborate and communicate transparently, receive feedback, keep relevant colleagues informed, and contribute to team goals.
Accountability for long- and short-term multifaceted projects.
Ability to engage varied audiences effectively in fast-paced, high-profile circumstances, orally and in writing, and communicate with discretion and professionalism with physician leaders and office staff, executives, and other stakeholders.
Ability to independently manage technical or complex, multistage projects from beginning to end.

Nice To Haves

At least 5 years of experience in a clinical and/or health plan environment.
Bachelor’s degree in business, public health, nursing, or a related area.
Active or inactive United States or territory license as a Licensed Vocational Nurse, Licensed Practical Nurse, Registered Nurse, or similar.
Certified coder or similar health information management credential.
Certification in healthcare quality or project management.
Outreach and other improvement initiative skills.
Successful experience as a team leader or supervisor.

Responsibilities

Support the design, piloting, and monitoring of HEDIS/Stars projects and oversee implementation as assigned.
Develop policies, procedures, and training materials, and deliver training.
Initiate and manage validation of supplemental data sources through primary source verification.
Maintain subject matter expertise, personally and across the team, on methods to close HEDIS gaps and exclusions, new medical technologies and medications, and locating relevant information in legal health records.
Monitor and address accuracy and productivity issues.
Lead medical record retrieval and review and related HEDIS compliance audit deliverables.
Manage assigned projects from beginning to end, including establishing timelines, coordinating, monitoring, troubleshooting, summarizing, and reporting deliverables.
Observe, track, and report opportunities for improvement and effective practices.
Onboard new abstraction and retrieval staff.
Perform other duties as assigned.