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Clinical Quality Analytics, Senior

  • Job
    Full-time
    Senior Level
  • Data
  • $99K - $148.5K
  • Long Beach, +1

AI generated summary

  • You need a bachelor's degree in health science or related field, 5 years of data analysis experience, 3 years in health care, 2 years with coding and claims data, and proficiency in SAS/SQL and MS Office. Experience with HEDIS measures and quality ratings is a must.
  • You will analyze data, develop reports, and support quality initiatives in healthcare to ensure high standards of care and improved health outcomes for BSC populations.

Requirements

  • Requires a bachelor’s degree in health science, quantitative social science, public health, health services research or business or equivalent experience
  • Prefer an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business
  • Requires at least 2 years of SAS/SQL programming experience
  • Requires at least 5 years of prior operational and / or data analysis experience, experience in database structures, and standard query and reporting tools
  • Proficient in MS Office – Word, Excel and Powerpoint
  • Requires at least 2 years of programming using inpatient claims, outpatient encounters, membership, pharmacy or laboratory data.
  • Requires at least 2 years of experience with ICD (International Classification of Diseases) codes, CPT (Current Procedural Terminology) codes, Diagnostic Related Group (APR-DRG/MS-DRG) codes or Healthcare Common Procedure Coding System (HCPCS) codes
  • Requires at least 3 years of experience in Health Care (managed care, academic, or gov't payer)
  • Requires at least 1 year of experience working with NCQA HEDIS quality measures
  • Requires at least 1 year of experience with NCQA Health Plan Rating, CMS Medicare Advantage Star Rating or Medi-Cal Managed Care Accountability Sets (MCAS)
  • Preferred experience with visual management (eg. Tableau, Power BI) or task management tools (eg. JIRA, Work Front, Sharepoint) or cloud data (eg. Azure, AWS, Snowflake)
  • Preferred- Mastery of at least two of the following: clinical coding, large-scale health databases, health statistics (e.g., epidemiology or health services), health insurance business principles. Must have sufficient familiarity with the technical and clinical concepts necessary to adequately perform the duties described above.
  • Experience developing SAS/SQL programs and scripts that can be passed on to other analysts to improve their work efficiency.
  • Must be able to develop programs and scripts that can be used to repeatedly to generate reliable reports and analytics
  • Strong verbal and written communication skills
  • Must exhibit level-appropriate competence in Departmental competency dimensions (Communication, Agile Learning, Business Knowledge, Creativity, Critical Thinking, Customer Focus, Drive for Results).
  • Capable of managing deadlines and working simultaneously on a variety of tasks
  • Experience with cost-of-healthcare or quality of care assessment in a managed care or academic setting
  • Experience utilizing a certified HEDIS software.

Responsibilities

  • Conduct independent analysis of high complexity under moderate supervision and guidance, develop novel analyses and reports
  • Develop documentation and create and execute workplans for analyses of high complexity
  • Produce analysis of high complexity under the guidance and direction of Clinical Quality Analyst – Consultant or Principal or Manager
  • Design, build, and enhance data systems and applications so that they better serve specific reporting requirements
  • Identify business risks relating to report design and production
  • Collect data from various internal systems (example Claims processing or membership systems) and external systems (EMR/EHR) and converts those data to actionable insights to guide business decision making for BSC populations' health management and quality of care
  • Produce monthly provider and/or employer group specific reports based on HEDIS measures in alignment with reporting quality ratings systems such as NCQA Stars/Accreditation, Medicare Stars, Medi-Cal Managed Care Accountability Sets, Quality Transformation Initiative and Quality Rating System
  • Partner with the HEDIS data team, Clinical Quality Analytics and Medical Record Review teams to support HEDIS performance improvement initiatives

FAQs

What is the primary responsibility of a Clinical Quality Analytics, Senior?

The primary responsibility of a Clinical Quality Analytics, Senior is to provide data, analytic, and reporting support for the Clinical Quality Department to improve quality performance for regulatory and accreditation requirements.

Who does the Clinical Quality Analytics, Senior report to?

The Clinical Quality Analytics, Senior will report to the Clinical Quality Manager or Senior Manager.

What are some of the regulatory and accreditation requirements that the Clinical Quality Analytics, Senior will be responsible for?

The Clinical Quality Analytics, Senior will be responsible for regulatory and accreditation requirements including National Committee for Quality Assurance, Centers for Medicare and Medicaid, and Department Health Care Service.

How does the Clinical Quality Analytics and Informatics team drive quality strategy and performance improvement?

The Clinical Quality Analytics and Informatics team delivers data, intelligence, and actionable insights to help drive quality strategy, performance improvement, and regulatory reporting.

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Finance
Industry
5001-10,000
Employees
1939
Founded Year

Mission & Purpose

Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. Blue Shield of California is a tax-paying, nonprofit, independent member of the Blue Shield Association with 4.7 million members, 7,800 employees, and $22.9 billion in annual revenue. Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.