Senior Clinical Quality Analyst

5 days ago

Long Beach, California, United States Blue Shield of California Full time

Role Overview

The Senior Clinical Quality Analyst plays a pivotal role in enhancing clinical quality performance through complex data analysis and reporting. This position involves the development of data systems, the execution of high-level analyses for improving healthcare quality metrics, and collaboration with various teams to support regulatory and accreditation compliance.

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

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 2 years of Tableau or Power BI development and visualization management
  • 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)
  • Tableau certifications preferred
  • Preferred experience with 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 preferred
  • 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
  • Must exhibit level-appropriate competence in Departmental competency dimensions (Communication, Agile Learning, Business Knowledge, Creativity, Critical Thinking, Customer Focus, Drive for Results)
  • Experience with cost-of-healthcare or quality of care assessment in a managed care or academic setting
  • Experience utilizing a certified HEDIS software.

Compensation

The estimated salary for this role is $99,000 to $148,500 per annum, based on California location.

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