Accreditation Specialist

Horizon Blue Cross Blue Shield of New Jersey•Hopewell, NJ

About The Position

This position will support Government Programs (GP) goal of improving quality of healthcare for our customers by ongoing monitoring of compliance with accreditation standards and regulatory requirements. This position will assist the Quality Management team in developing best practices for the coordination, facilitation, and oversight of all State and Federal accreditation activities.

Requirements

Requires Bachelors degree from an accredited college or university, preferably in Healthcare Management, or related field.
Requires a minimum of 3 years of experience in accreditation or regulatory field, (i.e NCQA, URAC, etc.)
In lieu of degree applicant must have a combination of an additional 5 years of equivalent and relevant work experience in managed care, preferably Medicaid.
Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint); Should be knowledgeable in the use of intranet and internet applications. including SharePoint and solid experience with Adobe
Requires knowledge of NCQA standards
Requires knowledge of state and federal regulations
Requires knowledge of managed care principles
Requires knowledge of project management.
Organizational and presentation skills
Communication skills, oral and written
Ability to prioritize and to multi-task in a fast-paced work environment.
Advanced planning and project management
Detail-orientation
Ability to plan and facilitate meetings.
Ability to effectively lead team members in diversified tasks
Priority setting and time management.

Responsibilities

Manages ongoing accreditation activity for all Government Programs lines of business to maintain the highest level of accreditation, including monitoring of standards, conducting gap analysis, and developing action plans to address identified deficiencies.
Ensures that all updates to accreditation standards, changes to State contracts and changes to CMS regulations, which affect accreditation are communicated to relevant departments, develops action plans to address the changes, and monitors compliance.
Creates and manages multiple accreditation project plans with tasks coordinated across departments at all levels of the organization.
Assembles accreditation project teams and assigns individual task responsibilities.
Ensures a continuous state of readiness for ongoing accreditation surveys and annual assessments.
Monitors delegates compliance with accreditation standards in collaboration with the Delegation and Vendor Oversight Department.
Educate and support operational area representatives in regard to accreditation requirements.
Interface with key staff and consultant(s) involved in accreditation survey/audit preparations and on-site survey/audit processes.
Maintain electronic accreditation libraries, ensuring all documentation is accurate and current.
Plans, coordinates and facilities training for internal and external stakeholders on aspects of accreditation Responsible for coordination of workflows and assignments for external reviews.
Participate in internal and external meetings as needed.