Quality Accreditation Coordinator
About The Position
The Quality and Accreditation Coordinator supports the organization's quality improvement, regulatory compliance, and NCQA accreditation activities. This role is responsible for assisting the Director of Quality Operations in coordinating quality programs, monitoring performance measures, supporting NCQA health plan accreditation surveys, maintaining required documentation, and collaborating with internal departments to ensure compliance with federal, state, and NCQA health plan accreditation standards. The coordinator assists in driving continuous quality improvement initiatives that improve member outcomes, operational performance, and health plan effectiveness.
Requirements
- HS Diploma required or Associate's degree in Healthcare Administration, Nursing, or related field.
- 2+ years of experience in managed care, Medicare, Medicaid, or health plan setting.
- Bilingual in English and Spanish.
- Relevant experience may substitute for the educational requirement on a year-for-year basis.
- Experience with NCQA health plan accreditation standards
- Knowledge of federal regulations and industry standards.
- Strong data analytical and problem-solving skills.
- Excellent communication and documentation abilities.
- Attention to detail with a focus on data integrity.
- Experience using Microsoft applications.
- Expert knowledge in Excel.
Responsibilities
- Review and analyze data across various areas, including claims, authorizations, grievances, appeals, case management, network adequacy, membership composition, and other related fields.
- Assist with QOC investigation, QIC Prep, monitoring, and auditing.
- Supports with preparation of evidence files and documentation for NCQA health plan accreditation surveys.
- Collects reporting for measurement and benchmarking of performance measures in relation to best practices for NCQA, CMS, and internal business objectives.
- Ensures data is accurate, reliable, and reported timely.
- Collects performance indicator reports and benchmark narratives for review by Director of Quality Operations for performance improvement recommendations.
- Assists with monitoring quality performance, outcomes, and/or metrics to make recommendations for targeted process improvement projects.
- Prepares overviews and interpretation of reports; and following up on assigned action items for various projects, meetings, and committees.
- Assists with accreditation and quality-related education to staff as needed.
- Assists with problem analysis for strategic planning initiatives.
- Solves data integrity issues as they arise, and monitor the addition of new data, analytics, and reporting systems.
- Assist with interpretation and translation of data for senior management for use in meaningful decision making, and strategic planning purposes.
- Assists with internal and external audits and preparation of audit responses.
- Collects supporting documentation to support review of Quality-of-Care concern investigations.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
