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Job Summary
COMPENSATION APPROVAL REQUIRED FOR POSTING.
This Position Is Responsible For Coordinating And Completing The Annual Analysis And Submission Of Hedis Information To Ncqa. Responsible For Coordinating Activities Of Internal Departments, External Partners, And External Vendors Also Responsible For Providing Support In The Planning, Coordinating, And Validating Quarterly Crms Database Builds.
- Coordinates and completes the annual analysis and HEDIS Medical record data collection and submission to NCQA.
- Support and ensure accuracy/compliancy during the NCQA required MRRV audit
- Coordinates the yearly HEDIS Survey Audit activities of internal departments (Quality, Nurses, Network, Communication/Publications), external provider partners , and contracted vendors (NCQA,).
- Responsible for HEDIS QI Work Plan management and revisions and IL Annual HEDIS Report.
- Attend Quality Improvement Committee and present dashboard on HEDIS and Pay for Performance annual analysis
- Participate in QI activities (Pay for Performance, HEDIS workgroup, CAHPS workgroup)
- Conduct oversee and monitor HEDIS activities throughout the year including submission/presentation of HEDIS reports to health plan quality committees, develop/monitor HEDIS timelines and annual Roadmap revisions.
- Conduct analysis of data and complete annual HEDIS and Pay for Performance reports and playbook
- Conduct HEDIS training for internal and external Quality staff
- Participate in HEDIS temp selection including resume review, interviewing and partnering with plan leadership and External Workforce Services on candidate recommendations
- Serve as liaison between the Enterprise and Illinois Plan
- Monitors NCQA and HEDIS program specifications and translate into report requirements.
- Maintains knowledge of HEDIS report software.
- Communicate and interact effectively and professionally with co-workers, management, customers, etc.
- Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
- Maintain complete confidentiality of company business.
- Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
JOB REQUIREMENTS:
- Registered Nurse (RN) or Clinician with unrestricted, Active license in state of operations
- Bachelor’s degree in a related field
- Knowledge of HEDIS Technical Specifications, guidelines and HEDIS survey process
- Minimum of 2 years experience with data analysis.
- Minimum of 2 years in a health care environment.
- Experience with NCQA Survey Requirements and HEDIS reporting.
- Experience utilizing various software packages including Excel, Access, and Word
- QSHR expertise including chase management, report queries, data analysis and clinical assignments
PREFERRED JOB REQUIREMENTS:
- Project Management Experience
- Ability to interpret Quality Compass and understand IDSS rates
- Skilled at managing multiple competing projects in a fast-paced environment with problem-solving abilities
- Health plan knowledge including LOB/products
- Exceptional communication and collaboration skills
#LI-Hybrid
*This role is a hybrid - 3 days in office 2 days work from home at our 300 E. Randolph Location
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
Pay Transparency Statement:
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
HCSC Employment Statement:
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range$60,300.00 - $133,400.00
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What We Do
Imagine Something New, Something Different.
Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families.
HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development.
HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC.
Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization.
Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
