Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers 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.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
Onsite: daily onsite requirement based on the essential functions of the job
Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building
Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This position is hybrid within the state of AZ only. This hybrid 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.
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…