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    • Data Analyst - Clinical Quality Senior - Oakland - Blue Shield of California

    Blue Shield of California
    Blue Shield of California Oakland

    1 month ago

    Default job background
    Description

    Company Overview:

    Blue Shield of California is a leading healthcare organization that delivers best-in-class clinical quality analytics and informatics to enable high-quality and affordable member-centered care.

    About the Role:

    We are seeking an experienced Data Analyst - Clinical Quality Senior to join our team. This role will provide data, analytic, and reporting support for the Clinical Quality Department to improve Blue Shield of California and Promise Health Plan quality performance for regulatory and accreditation requirements.

    Your Responsibilities:

    • You will 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 codes, CPT 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 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

    Pay Range:

    The estimated salary for this role is between $99,000 and $148,500 per year for California locations.

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