Capital BlueCross
Plan Performance Consultant (Finance)
Collaborating across the company with vendors and key internal and external stakeholders in order to drive improvements in plan performance as measured by HEDIS, STARS, accreditation status, etc.
Collaborating to maximize the data captured in support of year round HEDIS data collection
Participating in any and all activities needed to support our official HEDIS data collection and reporting
Participating in HEDIS standard and non-standard supplemental data collection, development and documentation of Road Map(s), abstraction, auditing, and other processes as needed and requested
Developing content for and publishing educational materials and support staff training and provider/member communications to supporting HEDIS Theon training materials, Performance Measures Guide, WebEx Provider Training, etc.
Interfacing with the Medical Policy area to ensure our medical policies align with HEDIS specifications
Serving as a liaison/trainer for the provider relations consultants to keep them informed of current information as it relates to HEDIS measurement and addressing gaps in care
Serving as a liaison with Capital's network providers to provide education and/or feedback on accuracy and status of processes to close care gaps and the submission of supplemental data
Serving as a liaison with Capital's corporate coding unit to ensure HEDIS specifications align with internal systems configuration
Participating in any and all required staff trainings; assisting in the development and/or presentation of training materials
Attending industry conferences and events, both local and national, to maintain a contemporary awareness of industry best practices, CMS regulations, Medicare Quality Improvement (HEDIS/STAR) solutions, benefits and programs that will enhance strategy development, recommendations and decision making.
Interacting with vendors to ensure compliance with accreditation and regulatory requirements and to ensure all deliverables for the Road Map(s) are established and completed for external auditors
Working collaboratively with Geneia as products and services are developed and implemented to support Capital's HEDIS efforts; participating in testing of new analytical functionality to ensure it is meeting Capital's needs and is in compliance with accreditation and regulatory requirements, participating in meetings requiring clinical decision makers, and drafting responses to share with department leadership related to any changes or updated to products and services.
Promoting a positive public image and effectively and efficiently developing and facilitating relationships with both internal and external stakeholders that will leverage the success of the organization to improve health and care of membership.
Supporting the design, development, and implementation of clinical/quality initiatives focused on improving health outcomes for our members
Providing oversight of day to day operations related to supplemental data submission including, but not limited to, monitoring and tracking submissions and backlog, developing plans to resolve backlog as necessary, and managing temp staff as needed to process submissions in a timely manner.
Knowledge:
Knowledge of and work experience operating a PC and software
Knowledge of NCQA and HEDIS/STARS measurement
Skills:
PC literacy and ability to perform electronic research and respond to electronic requests
Proficiency in Excel and other Microsoft software
Possesses strong organizational, research, and analytical problem solving skills
Ability to prioritize and complete work assignments independently and within set deadlines and adjust to changing work requirements
Ability to communicate effectively and professionally, both verbally and in writing with all levels of personnel, both internal and external
Experience:
Experience with NCQA and HEDIS/STARS measurements highly desirable
Education, Certification, and Licenses:
Bachelor's degree in a health-related field or Bachelor's degree with 3 years healthcare experience
Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.