Your Role
The Clinical Quality Analytics and Informatics team delivers best-in-class clinical quality analytics and informatics to enable high quality and affordable member-centered care. Our data, intelligence, and actionable insights help drive quality strategy, performance improvement, and regulatory reporting. The Clinical Quality Analyst - Senior will report to the Clinical Quality Manager or Senior Manager. In this role you will provide data, analytic and reporting support for the Clinical Quality Department to improve Blue Shield of California and Promise Health Plan quality performance for regulatory and accreditation requirements including National Committee for Quality Assurance, Centers for Medicare and Medicaid and Department Health Care Service.
Your Work
Essential Functions include but not limited to:
- Conducts analysis of moderate complexity and develops reports with guidance from manager and peers
- Communicates analytical results in graphs or summaries to various stakeholders
- Prepares presentation materials that clearly convey information to appropriate internal and external BlueShield audiences
- Designs, builds, and enhances data systems and applications so that they better serve specific reporting requirements
- Assist to develop documentation for all new and existing SAS programs
- Reviews and revises existing analytical processes for accuracy and efficiency
- Identifies existing inefficiencies and problems and takes action to implement solutions
- Assists junior team members through peer review, informal training, or mentoring
- Seeks and provides advice to analysts in other departments and business units regarding standardization of business rules and methods for analysis and reporting
- Produces accurate results under tight deadlines
- Continuously refines and expands the technical, clinical, and financial content knowledge required to successfully complete these duties
- Develops, implements, and documents quality assurance (QA) processes to ensure that reported data is accurate and reliable
- Recommends and implements solutions for identified problems/root cause pertaining to clinical data used for HEDIS reporting
- Provide advanced analytical support for business operations in all or some of the following areas: claims, provider data, member data, clinical data, HEDIS, pharmacy, or, external reporting
- Contributes to team success by accomplishing tasks as needed
Your Knowledge and Experience
- 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 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 SAS/SQL programming experience
- 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)
- 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 preferred
- Experience developing SAS/SQL programs and scripts that can be passed on to other analysts to improve their work efficiency preferred
- 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 preferred
Pay Range:
The pay range for this role is: $ 99000.00 to $ 148500.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
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Clinical Quality Analytics, Senior at Blue Shield of California summary:
The Clinical Quality Analytics, Senior role focuses on delivering clinical quality analytics and informatics for member-centered care. This position involves conducting data analysis, developing reporting systems, and ensuring accuracy in clinical data for regulatory compliance. The role requires advanced analytical skills and experience in health care to drive quality improvement and support business operations.
Keywords:
clinical quality analytics, data analysis, healthcare performance improvement, SAS programming, HEDIS reporting, regulatory compliance, healthcare analytics, data reporting, quality assurance, health services research
