Lead HEDIS Specialist - Hybrid

Blue Cross Blue Shield of Arizona•Phoenix, AZ

14d•Hybrid

About The Position

This position leads Blue Cross Blue Shield of Arizona’s National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS®) initiatives, including training, implementation, and reporting for medical record retrieval, review (MRR), and overread. It supports the design, piloting, and monitoring of HEDIS/Stars projects and oversees implementation as assigned. The role develops policies, procedures, and training materials; delivers training; and leads medical record review and related HEDIS compliance audit deliverables. The position manages projects from beginning to end, including setting timelines, coordinating work, monitoring progress, troubleshooting, and summarizing and reporting deliverables. It validates supplemental data sources through primary source verification, monitors accuracy and productivity, onboards new abstraction and retrieval staff, and helps the team maintain expertise in HEDIS gap closure, exclusions, new medical technologies, medications, and locating relevant information in the legal health record. The role serves internal customers such as administrators, managers, and staff, and external customers including accreditation and regulatory organizations, peer review organizations, payers, patients, healthcare providers, clinical registries, and databases. This is a full-time hybrid position within Arizona, with an onsite expectation of one day per week. Full-time is defined as at least 40 hours per week, plus additional hours as requested or needed to meet business requirements.

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, including setting timelines, coordinating, monitoring, troubleshooting, summarizing, and reporting deliverables.
Ability to troubleshoot basic desktop and login issues, using the Help Desk when needed.
Advanced proficiency with software applications and/or vendor tools used to manage or conduct HEDIS activities.
Basic proficiency with Microsoft Teams, email, Outlook calendar, and Excel functions including filtering and sorting; ability to highlight, mark up, and remove PDF pages; and manage files using OneDrive and Windows Explorer.
Familiarity with legal health records, their contents and search techniques, electronic medical records, health information exchanges, and clinical registries; ability to interpret and communicate clinical information in English.
Ability to work effectively in a paperless environment, manage time and productivity, adapt to changing tasks and overlapping project timelines, and meet deadlines.
Strong organizational skills, including note-taking, and ability to use checklists and other quality checks to ensure accurate, complete, high-quality work.
Working knowledge of NCQA HEDIS Compliance Audit deliverables and processes.
Analytical skills to evaluate available information and make decisions.
Ability to manage assignments, time, and priorities independently; collaborate transparently; communicate with leadership and coworkers; and remain open to feedback.
Ability to interpret and apply policies, procedures, performance measure specifications, and different measurement methodologies.
Ability to interpret and implement HEDIS or similar technical specifications at an intermediate level and update knowledge when specifications change.
Ability to comply with policies, procedures, and regulations for confidentiality and privacy.
Sound independent judgment and problem-solving skills.
Ability to manage multiple tasks in a demanding, fast-paced environment while keeping relevant stakeholders informed.
Ability to work with minimal supervision, take initiative, overcome barriers, and lead work with stakeholders and analysts.
Ability to share relevant information, offer suggestions and resources, volunteer for assignments, and help remove barriers to team goals.
Accountability for long- and short-term multifaceted projects.
Strong ability to engage varied audiences in fast-paced, high-profile circumstances, orally and in writing.
Ability to 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 license in any U.S. state or territory as a Licensed Vocational Nurse, Licensed Practical Nurse, Registered Nurse, or similar license.
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 project-manage validation of supplemental data sources through primary source verification.
Maintain subject matter expertise, individually and across the team, on methods for closing HEDIS gaps and exclusions, new medical technologies, medications, and locating relevant data in legal health records.
Monitor and address accuracy and productivity issues.
Lead medical record review and related HEDIS compliance audit deliverables.
Manage assignments from beginning to end by establishing timelines, coordinating, monitoring, troubleshooting, summarizing, and reporting on project deliverables.
Track and report opportunities for improvement and effective practices.
Onboard new abstraction and retrieval staff.
Perform other duties as assigned.