Job Information
CareFirst Senior Quality Analyst (Hybrid) in Baltimore, Maryland
Salary Range Disclaimer
PURPOSE:
Plans, organizes, and manages large scale or complex projects for successful delivery of RAF and Risk Revenue/HCC projections for multiple LOB's. Initiates, engages, and motivates cross-functional teams to deliver optimal results for Provider Partnerships. Identifies and mitigates risk and escalates as needed. Tracks progress and drives documentation to support project needs. Ensures end to end leadership for implementations, integration, business readiness and communications.
ESSENTIAL FUNCTIONS:
Plans and initiates RAF Risk Revenue and HCC monthly accruals for Prospective and Retrospective activities. Prepares budgets, monitors progress, tracks schedule and serves as a point of contact for Actuarial and Finance Teams. Sequences complex initiatives from start to finish with multiple analytical vendors. Creates dashboards and reporting packages for provider groups and P&L leadership.
Provides end to end project management support in terms of reporting, project deliverable tracking and documentation for risk adjustment activities with Provider Partnerships on the DSNP EGWP and MAPD LOB. Acts as a liaison across all areas to ensure effective and efficient goals, scope, progress, and completion of projects. Coordinates issues throughout CareFirst, and externally, when necessary, to promote accurately represented information.
Provides direction and motivation to encounter submission and analytical project teams in a matrixed environment. Drives outcomes for program Return on Investment by fostering a collaborative culture. Manages relationships with key stakeholders, including management and vendors. Leads the execution of the project subsequent to annual bids.
Evaluates implications of existing or proposed projects, programs, processes, and policies/regulations through the use of critical and creative thinking and recommends improvements.
Performs mid-level advisory consulting work and provides strategic focus. Effectively conveys the big picture and alignment with corporate goals.
Synthesizes complex topics and project statuses into executive level presentations and influences decision making with product leadership for optimized financial reconciliation of Quality Team billing and payables. Effectively communicates with all levels of the organization on budget needs and year to date trends. Liaisons with P&L ownership on DSNP and EGWP business lines and translates business needs into technology related action plans.
SUPERVISORY RESPONSIBILITY:
Leads a team utilizing a matrix management system.
QUALIFICATIONS:
Education Level: Bachelor's Degree Preferred in Project Management, Finance Business or related field OR in lieu of a Bachelor's degree, an additional 5 years of relevant work experience is required in addition to the required work experience.
Experience: 5 years as a risk adjustment HCC analyst or experience collaborating with Finance and Actuary Teams.
Preferred Qualifications:
Certification in Quality or Process Improvement Methods
Direct experience with accreditation, HEDIS, CAHPS and other quality related activities a healthcare relatedenvironment and/or payor organization.
Knowledge, Skills and Abilities (KSAs)
Project planning and life cycle development.
Ability to engage staff at project start-up and plans roll-off of staff at project end.
Effective understanding of how functions integrate within the division and the strategic concept behind the corporate goals.
Ability to synthesize large complex data and analysis into clear, concise, executive level presentations that allow for rapid grasp of business problem or opportunity and understanding of feasible solutions.
Stakeholder management and facilitation, including conducting high-level status meetings with executives.
Ability to establish working relationships and influence/persuade across all levels of leadership including C-Suite.
Ability to identify and shepherd strategic opportunities that have a significant impact on the organization.
Use of Microsoft Office applications.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $82,728 - $164,307
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Risk Adjustment
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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REQNUMBER: 19822