HEDIS Technical Manager
BlueCross BlueShield of Tennessee
full-time
Posted on:
Location Type: Remote
Location: Tennessee • United States
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Tech Stack
About the role
- 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.
Requirements
- 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
- 8 years - Extensive systems analysis, design and project management experience required.
- 5 years - Experience in a leadership/management role required
- Bachelor's Degree in a Business, Computer Sciences or related fields or equivalent work experience
- 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
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
HEDIS experienceHEDIS specificationsHEDIS codesHEDIS audit requirementsSQLGoogle BigQueryGCPdigital HEDIS measuresinteroperability standardsNCQA quality reporting models
Soft Skills
leadershipcommunicationinterpersonal skillsorganizational skillsproblem-solvingself-motivationtask managementprioritizationvendor managementteam collaboration