Blue Shield of California · 12 hours ago
Clinical Quality Analytics, Senior
Long Beach, CA, United States
Full-time
Hybrid
Mid, Senior Level
$116K/yr - $174K/yr
5+ years expBlue Shield of California is a nonprofit organization focused on transforming healthcare to improve quality and affordability. The Clinical Quality Analyst - Senior will provide data, analytic, and reporting support to enhance quality performance for regulatory and accreditation requirements, ensuring high-quality member-centered care.
Financial ServicesHealth InsuranceNon Profit
No H1B
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 convert 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
Qualification
Required
Requires a bachelor's degree in health science, quantitative social science, public health, health services research or business or equivalent experience
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
Prefer an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business
Experience with visual management (e.g. Tableau, Power BI) or task management tools (e.g. JIRA, Work Front, SharePoint) or cloud data (e.g. Azure, AWS, Snowflake) preferred
Experience with two of the following is preferred: clinical coding, large-scale health databases, health statistics (e.g., epidemiology or health services), health insurance business principles
Experience developing SAS/SQL programs and scripts that can be passed on to other analysts to improve their work efficiency preferred
Ability to develop programs and scripts that can be used to repeatedly generate reliable reports and analytics preferred
Experience with cost-of-healthcare or quality of care assessment in a managed care or academic setting preferred
Experience utilizing a certified HEDIS software
Company
Blue Shield of California
Blue Shield of California is a health insurance service provider.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Gary Culp
Senior Vice President, Government Markets
Gregory Siebert
Senior Vice President Provider Partnerships & Network Management
Recent News
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