Clinical Quality Systems Specialist

Clinical Quality Systems Specialist

Reporting to the Clinical Data Systems Lead, the Clinical Quality Systems Specialist serves as a trusted collaborator in advancing the use and quality of data within the Health Analytics system and clinical data for the enterprise. This position works closely with the Business Analyst, IT&S, business units, and subject matter experts in the analysis, documentation, testing, and project management of business requirements throughout the life of the project and will ensure that requirements are fully understood and implemented by both the technical team and business units. This position ensures the effective implementation of clinical data and quality measure projects and the operation of the Health Analytics system.

This position is eligible to work onsite, remote or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us

Make a Positive Impact : Your work will directly contribute to the health and well-being of Kansans.

Family Comes First : Total rewards package that promotes the idea of family first for all employees.

Professional Growth Opportunities : Advance your career with ongoing training and development programs.

Dynamic Work Environment : Collaborate with a team of passionate and driven individuals.

Trust : Work for one of the most trusted companies in Kansas

Stability : 80 years of commitment, compassion and community

Flexibility : Options to work onsite, hybrid or remote available

Compensation

26.34 - $31.30 hourly Non-Exempt 13

Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

What you'll do

Serve as a central point of communication between Information Services (IS) and corporate users regarding health analytics related system development, problems, and modifications.

Maintain a systematic knowledge of health analytics systems like HEDIS engines, FHIR / Integration Engines, etc., membership / eligibility system, QMF / SQL, and other systems used in the department.

Perform in-depth testing of system solutions and new systems and modifications to existing systems supporting departmental functions. Documenting and providing details of issues found and finding resolutions with appropriate parties.

Responsible for the data integrity and maintenance of clinical data records and all databases in the health analytics system.

Define and maintain test and regression test scenarios that are used for each system update.

Evaluate, research, and resolve user identified system problems and document the conclusions.

Identify and create Service Requests (SR) for system enhancements and fixes.

Maintains status / backlog documentation.

Knowledge / Skills / Abilities

Thorough understanding of system testing principles, including setting up test cases and verifying test results.

Proficient in SQL / QMF and other systems commonly used for Membership, Clinical Data.

Strong analytical and problem-solving skills with the ability to present facts logically.

Excellent communication skills, capable of effective training and system assistance.

Knowledge of HIPAA regulations and clinical data coding systems (ICD, LOINC, SNOMED, CPT, HCPCS).

Ability to work independently and manage multiple projects with critical deadlines.

Familiarity with Agile software development and project management methodologies.

High degree of accuracy and attention to detail required in all work.

Education and Experience

High school graduate or equivalent required; bachelor's degree in computer science, Business Administration, Economics, Accounting, or similar preferred.

Must have 1 year experience in claims, customer service, membership, provider relations or health analytics.

Experience using the principles of system testing, how to thoroughly test a system when changes occur to include setting up test cases, ensuring extreme values are tested in all cases and verifying the results of both valid and invalid input, is preferred.

Exposure to provider claim coding data and systems testing preferred.

Benefits & Perks

Base pay is only one component of your competitive Total Rewards package

Incentive pay program (EPIP)

Health / Vision / Dental insurance

6 weeks paid parental leave for new mothers and fathers

Fertility / Adoption assistance

2 weeks paid caregiver leave

5% 401(k) plan matching

Tuition reimbursement

Health & fitness benefits, discounts and resources

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.