FEP HEDIS Coordinator - Hybrid

Coordination of the Healthcare Effectiveness Data and Information Set (HEDIS) Audit, roadmap preparation, data collection and reporting processes in addition to HEDIS intervention activities to improve related clinical performance measures for the FEP lines of business. Additionally, this position will take a lead role in coordinating the efforts to improve and is responsible for coordination activities related to the HEDIS measures for FEP. Serves as the liaison with Network Management, Health Services, Finance, Informatics, Federal Employee Program (FEP) and other ad hoc departments and programs as necessary

REQUIRED QUALIFICATIONS

Required Work Experience

• 2 years of HEDIS experience including analytics
• 1 year of quality improvement experience
• 1 year experience in analytics

Required Education

• High-School Diploma or GED in general field of study

Required Licenses

• N/A

Required Certifications

• N/A
  

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 1 year(s) of experience in health insurance, or other health care related field
• Project experience
• Clinical experience / background

Preferred Education

• Bachelors degree in business, Analytics or related field
• Associates degree in nursing or healthcare field

Preferred Licenses

• N/A

Preferred Certifications

• N/A

• Provide timely FEP HEDIS measure status reporting, including trending and analyzing of the data
• Development and execution of FEP HEDIS intervention steps to improve targeted measures
• Participate in the FEP HEDIS postmortem analysis to increase rates and evaluate and analyze annual FEP HEDIS rates
• Define objectives, processing requirements and specifications to document steps taken and results achieved related to HEDIS results
• Assist in coordinating new enhancements, including system enhancements and report generation, to improve FEP HEDIS scores
• Create ad-hoc reports to assist with the tracking of the FEP HEDIS measures
• Interpret, communicate and present results in a consistent and easy to understand format that facilitates fact-based decision making
• Display initiative in researching beyond the specific assignment
• Along with research, create analyses and recommendations that will allow FEP to meet the HEDIS goals
• Incorporate strategic planning and then breaking down high-level project information into manageable components to define and forecast work components
• Participate and/or coordinate projects with the HEDIS interdepartmental team, building and maintain a good working relationship with internal and external stakeholders and key contacts
• Demonstrate and maintain current working knowledge of the required BCBSAZ systems
• Maintain all standards in consideration of State, Federal, FEP, BCBSAZ and other applicable regulatory/accrediting agency requirements as they apply to department functions

• 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.
• Perform all other duties as assigned

LEAD

• Ability to perform the essential job functions outlined above.
• Coordinate completion of FEP HEDIS roadmap in conjunction with FEP initiatives and mandates
• Develop and respond to FEP HEDIS Audit Corrective Action Plan (CAP) as necessary
• Develop and maintain the FEP HEDIS training manual and documentation in accordance with department standards, including industry best practices
• Development of work plan and tracking of the FEP HEDIS quality improvement Intervention Measures
• Develop and respond to the FEP yearly business plan
• Develop and implement key HEDIS initiatives/activities through collaboration/coordination with the FEP Field Service Team