Accreditation Specialist - Jefferson Health Plan
About The Position
Working under general supervision, the Accreditation Specialist is responsible for assisting with ongoing compliance with National Committee for Quality Assurance (NCQA) and supporting the Manager, Accreditation with accreditation related projects. Under the direction of the Manager, Accreditation, the Accreditation Specialist will coordinate accreditation preparedness and maintenance activities to ensure continual readiness for NCQA Accreditation. The Accreditation Specialist supports the manager in the ongoing monitoring of NCQA and related regulatory standards and the ongoing review of compliance with new and existing standards. The specialist will suggest opportunities for improvement to assure full standards compliance in all measured areas. The specialist will review NCQA updates and FAQs and provide updates to all key stakeholders on changes to standards or processes. The Accreditation Specialist will report to the Manager, Accreditation. Job Description Interface with internal and external clients, committees and departments in the review of data and in the implementation of appropriate interventions to effect improvement. Assist key Health Partners Plans’ business units with understanding the NCQA standards. Collect and prepare the documents for survey submission; annotate, bookmark. Assist with Health Outcomes Survey (3 year cycle) Assist with Health Plan Survey - Medicaid (3 year cycle) Assist with Health Plan Survey - Exchanges PPO (3 year cycle) Assist with Health Plan Survey - Exchanges HMO (3 year cycle) Assist with LTSS Survey (3 year cycle) Participate in Report template creation and updates Crosswalk of policy and standard changes Assist with Workplan Updates Serve as subject matter expert regarding evaluating, interpreting and summarizing NCQA standards, Accreditation requirements, report writing, and policies and procedures Assist with Mock File Review, training, and communication needs Identify gaps in evidence and compliance Participate in Accreditation Committee Meetings Perform other duties as assigned.
Requirements
- Bachelor’s Degree Healthcare or Business Required
- 3 years NCQA Experience, Compliance, Audit experience
- 2 years Managed Care Experience required
Nice To Haves
- Master’s Degree Healthcare or Business Preferred
- No less than 1 year of successful NCQA Accreditation process completion and continuous process improvement experience preferred
Responsibilities
- Interface with internal and external clients, committees and departments in the review of data and in the implementation of appropriate interventions to effect improvement.
- Assist key Health Partners Plans’ business units with understanding the NCQA standards.
- Collect and prepare the documents for survey submission; annotate, bookmark.
- Assist with Health Outcomes Survey (3 year cycle)
- Assist with Health Plan Survey - Medicaid (3 year cycle)
- Assist with Health Plan Survey - Exchanges PPO (3 year cycle)
- Assist with Health Plan Survey - Exchanges HMO (3 year cycle)
- Assist with LTSS Survey (3 year cycle)
- Participate in Report template creation and updates
- Crosswalk of policy and standard changes
- Assist with Workplan Updates
- Serve as subject matter expert regarding evaluating, interpreting and summarizing NCQA standards, Accreditation requirements, report writing, and policies and procedures
- Assist with Mock File Review, training, and communication needs
- Identify gaps in evidence and compliance
- Participate in Accreditation Committee Meetings
- Perform other duties as assigned.
Benefits
- Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
- Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
- All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
