Blue Cross Blue Shield of Arizona

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Medicare Advantage - Strategy Analyst- Lead

at Blue Cross Blue Shield of Arizona

Posted: 11/21/2019
Job Reference #: 5385
Categories: Other/General
Keywords: company

Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,400 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

Purpose of the Job
This hybrid role will collaborate with Quality STAR and Risk Revenue Leadership Team and lead BCBSAZ Advantage’s vendor management, program launch, and process improvement strategy.  Position will serve as an internal consultant for activities supporting the STAR Ratings including HEDIS CAHPS and HOS.  Position will also provide strategic vision towards best practices for the complete and accurate capture of risk adjustment data via prospective and retrospective programs. The Lead strategy Analyst will employ strong analytic, consultative and communication skills to develop and execute strategies related projects and programs (internal and vendor-driven) that optimize performance across our provider networks serving Medicare markets. This position will utilize qualitative and quantitative information and assessments to attain enterprise business division goals and report to the Director of Quality STAR and Risk Revenue Programs.

Essential Functions and Job Responsibilities
1.    Strategic Development
• Partnering with the Vice President of Quality STAR and Risk Revenue Programs to utilize performance analysis methods to identify and recommend opportunities for process improvement across the department.
• Actively participate in the development of the 3-year strategic plan for BCBSAZ Advantage Quality STAR and Risk Revenue Programs.
• Monitor and evaluate progress against timelines, project milestones and key deliverables for HEDIS CAHPS HOS Prospective and Retrospective Risk Revenue Programs.
• Coordinate efforts with Compliance and industry advocacy groups to support a comprehensive understanding of CMS guidance for quality and risk adjustment policies and procedures
2.   Vendor Program Oversight
• Develop and maintain vendor scorecards to ensure direct communication with vendors on improvement opportunities
• Participate in the contract negotiation phase including the RFP process implementation of service level agreements and settlement of any disputes within the BCBSAZ vendor portfolio
• Works with STAR Manager on CAHPS and Health Outcomes Surveys vendor-strategy and subsequent vendor contracts and weekly calls.  Works with Risk Adjustment Manager managing vendors for the prospective and retrospective programs
• Identifies opportunities for improvement within vendor contracting structure.  Leads discussions on vendor strategy best practices within Medical Management vertical also partnering with Case Management and Pharmacy Teams.
3.    Reporting and Presentation
• Collaborating across business divisions with various departments such as Operations, Actuarial and Finance to coordinate the development of centralized dashboards/models to identify and track Quality STAR and Risk Revenue progress.  Also partners with equivalent staff at Banner Health Network to promote centralized reporting
• Uses technical skill set to centralize reporting package and project plans for Quality STAR and Risk Revenue annual projects
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned.

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Skill / Requirements

Required Qualifications1. Required Work Experience• Five (5) years in a progressively responsible leadership consulting or project management role in a complex operational vertical supporting health care and vendor-based programs.• Three (3) years’ experience supporting Quality/STAR programs (HEDIS CAHPS, HOS) or Risk Revenue (Chart Retrieval & Coding, In-Home Assessment, Annual Well Visits, Member Outreach) Programs for Medicare Advantage.2. Required Education• High-School Diploma or GED in general field of study.3. Required Licenses• N/A4. Required Certifications• N/APreferred Qualifications1. Preferred Work Experience• Seven (7) years’ experience with a Medicare Advantage plan or other health care related field managing high-level projects and vendor relationships.2. Preferred Education• Master’s in Healthcare, Business Administration, Finance or a related field3. Preferred Licenses• N/A4. Preferred Certifications• PMP CertificateRequired Competencies1. Required Job Skills• Understanding of member targeting methodologies used in the Medicare Advantage industry for Risk Adjustment Gap-Closure Programs.• Previous experience working in strategy development and implementation, analytical and Quality-based process improvement in the health care health insurance sector or management analytics.• Technical Skillso Microsoft Access, Microsoft Excel, Microsoft PowerPoint (Advanced)o SharePoint (Advanced)o SQL Server (Intermediate)2. Required Professional Competencies• Ability to hold vendors accountable for program performance• Demonstrated analytical and critical thinking skills• Demonstrated interpersonal/verbal communication skills• Demonstrated written communication skills• Ability to work in a matrixed environment• Ability to work as part of a team• Ability to manage a project-based portfolio with constant deliverables• Adept at partnership and collaboration both internally with Medical Management verticals and externally to Finance, Information Technology and PMO.3. Required Leadership Experience and Competencies• Strong leadership skills with proven ability to lead change to accommodate evolving organizational and regulatory processes.Preferred Competencies1. Preferred Job Skills• SQL Server System (Advanced)2. Preferred Professional Competencies• N/A3. Preferred Leadership Experience and Competencies• N/A

Application Instructions

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