Premera Blue Cross Hiring for HEDIS Administrator I at United States Full Time

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

COVID-19 Vaccination Policy:

On September 9, President Joe Biden issued an executive order requiring the vaccination of employees at federal contractors. Premera Blue Cross, as a health plan within the federal employee benefits program, is designated as a federal contractor. Premera has implemented a new requirement for all employees, including telecommuters, to either show proof of being fully vaccinated from COVID-19 or have an approved medical or religious accommodation (based on a disability/medical condition or sincerely held religious belief), by January 1, 2022. From the onset of the pandemic, Premera has remained committed to the health and well-being of our employees, customers and communities.

As a new employee you will be required to show proof of being fully vaccinated or submit for an accommodation within your first five days of employment.

As a HEDIS Administrator I , your work is critical to the company’s HEDIS® quality reporting. You will facilitate provider file transfer validations, medical record retrieval, overread validations, and analysis of reported HEDIS® Hybrid Measure outcomes to comply with state, federal, and accreditation requirements. You will have the opportunity to participate in quality projects and process improvements to achieve goals and improve outcomes.

What you’ll do:

• Collaborate with team members across the Quality Program team to accomplish provider file transfer validations, medical record retrievals, and other time-driven goals

• Perform medical record retrievals and reviews remotely, on-site paper, or electronic medical charts (EMR/EHR systems) in variable settings

• Review and abstract paper and electronic medical records using HEDIS® Technical Specifications as they relate to Premera’s clinical quality initiatives

• Facilitate and obtain appropriate provider documentation for clinical conditions and procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care for the patient

• Manage to and meet strict deadlines, to complete the annual HEDIS® audit and monthly report runs

• Perform accurate data entry as well as seek out patterns of missing documentation of additional records

What you’ll bring:

• High school diploma or 1-year of experience in Health Care Administration, Health Education, Nursing or related field Medical Record, Health plan, or Provider Office experience (Required)

• HEDIS® knowledge or experience

• Experience with provider electronic medical records systems

• Experience with reviewing medical records

• 2 years of complex program or project management experience

• Experience in implementing programs and processes to meet regulatory and accreditation requirements

• Medical knowledge/terminology and the ability to read and interpret medical records

• Working knowledge of NCQA HEDIS® Hybrid Measures

What we offer

• Medical, vision and dental coverage

• Life and disability insurance

• Retirement programs (401K employer match and pension plan)

• Wellness incentives, onsite services, a discount program and more

• Tuition assistance for undergraduate and graduate degrees

• Generous Paid Time Off to reenergize

• Free parking

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [email protected] or via phone at 425-918-4785.

At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.

As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.

Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.