Quality Reporting Specialist

Centene Corporation•Tempe, AZ

1d•Hybrid

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. This role is primarily remote, with a requirement to be in the Tempe office once every three weeks, along with occasional visits to provider offices to retrieve medical records. Candidates must reside in Arizona. The purpose of this position is to organize and assemble various quality indicators which are reported to the Quality Management Risk Management Committee. It also involves coordinating Quality of Care (QOC) tracking processes and operational department reporting to ensure timely submission to payors. The specialist will prepare Quality Improvement (QI) reports for review prior to submission, track incident, accident, and death (IAD) reports, and correspond to QOC investigations to ensure timely resolution and appropriate information provision to the payor. Further responsibilities include organizing and assembling IAD and QOC data for various committees, ensuring timely report submissions from all departments to Payors, participating in the Risk Committee or other designated committees, conducting audits of the State IAD-QOC database for data integrity and timeliness, preparing provider financial sanctions for review, and serving as the primary point of contact for provider issues regarding IADs and QOCs.

Requirements

High school diploma or equivalent
2+ years of experience in a health care setting that includes coordination of member care through physicians, clinical nurses and office managers
In depth knowledge of medical/mental health terminology required

Responsibilities

Organize and assemble various quality indicators which are reported to the Quality Management Risk Management Committee
Coordinate Quality of Care (QOC) tracking process and the operational department reporting to ensure timely submission to the payors
Prepare Quality Improvement (QI) reports and submit for review prior to submission
Track incident, accident, and death (IAD) reports and correspond to QOC investigations to ensure resolution meets the timeliness standards and ensure appropriate information is provided the payor
Organize and assemble IAD and QOC data for the QM Committee, the Credentialing Committee, and other entities
Ensure that all departments submit reports timely to the Payors
Participate in the Risk Committee or other appropriate committees as designated
Conduct audits of the State IAD-QOC database to ensure data integrity and timeliness of portal submissions
Prepare provider financial sanctions for review prior to submission
Serve as primary point of contact to resolve provider issues regarding IADs and QOCs