[Hiring] HEDIS Technical Manager @BlueCross BlueShield of Tennessee

Role Description

In this critical leadership role, you’ll own the technical execution of our HEDIS program, with primary responsibility for HEDIS reporting systems, audits, and vendor delivery that support NCQA accreditation and Medicare Advantage Star Ratings. In addition to managing our Cotiviti relationship (and a team of internal specialists), you’ll serve as the technical authority for HEDIS specifications, digital measures and audit response.

• Works with internal and external stakeholders to deliver effective analytic solutions that meet business needs.
• Assesses the scope and resources required for a wide variety of analytic requests, data modifications and enhancements, and special projects.
• Identifies necessary resource requirements and tracks assignments to ensure timely completion.
• Escalates issues appropriately and works with senior management for resolution.
• Monitors and communicates key performance metrics and operational challenges.

Qualifications

• Bachelor's Degree in a Business, Computer Sciences or related fields or equivalent work experience.
• 8 years - Extensive systems analysis, design and project management experience required.
• 5 years - Experience in a leadership/management role required.
• Deep payer-side HEDIS experience, including strong clinical and technical understanding of HEDIS specifications, codes, and audit requirements.
• Hands-on experience owning or leading HEDIS audits and responding to NCQA audit inquiries.
• Vendor management experience with HEDIS Cotiviti Platform (or similar HEDIS platform).
• Technical fluency with healthcare data and analytics (SQL, Google BigQuery, GCP experience).
• Familiarity with digital HEDIS measures, interoperability standards (FHIR), and evolving NCQA quality reporting models.
• Ability to comprehend technical instructions and explain/breakdown problems and issues.
• Working knowledge of healthcare claims, customer service, provider network contracting, and contract compliance.
• Demonstrated ability to effectively work with senior leadership teams.
• Proven leadership abilities that promote growth and development of employees.
• Self-motivated and able to manage multiple tasks and set priorities.
• Excellent oral and written communication skills.
• Strong interpersonal and organizational skills.
• Possess interviewing and hiring skills.

Requirements

• Number of Openings Available: 1
• Worker Type: Employee

Company Description

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.