Accreditation Specialist

WellSense Health Plan; Boston (MA); On-site; USD 65,000 - 85,000; Full time

Job summary

A growing regional health insurance company is seeking an Accreditation Specialist to lead quality improvement efforts and ensure NCQA accreditation. The role involves developing documentation, overseeing committee logistics, and collaborating with various partners. Candidates should hold a Bachelor’s degree and have at least 2 years of healthcare experience. This position offers a chance to impact quality initiatives in a diverse workplace.

Qualifications

• 2 years of experience in a healthcare environment.
• Knowledge of HEDIS measure technical specifications (preferred).

Responsibilities

• Lead coordination of quality improvement efforts for accreditation.
• Prepare documentation for NCQA and other accreditation surveys.
• Oversee logistics for accreditation committees.

Skills

Facilitate process improvement efforts

High proficiency in Microsoft Office

Strong interpersonal skills

Lead cross-functional groups

Education

Bachelor’s degree or equivalent

Master’s degree in related field (preferred)

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Microsoft Visio

Job description

Accreditation Specialist

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It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary

The Accreditation Specialist will lead coordination of quality improvement efforts and deliverables to obtain NCQA Health Plan Accreditation. Leads the Plan’s efforts to attain and maintain accreditation, which involves collaboration with both internal and external partners to identify, launch, and implement projects and initiatives that support achievement and maintenance of accreditation.

Key Functions/Responsibilities

• Develops and prepares documentation for NCQA and other accreditation surveys submissions.
• Oversees organizational logistics for required committees and documentation to include material preparation, meeting minutes, etc.
• Works closely with business leads to build and document compliance with accreditation standards.
• Advises on the development and distribution of accreditation best practices.
• Develops and reviews policies and procedures that support accreditation activities.
• Interfaces with accreditation agencies and other state regulatory bodies.
• Organizes and/or participates in readiness assessments in preparation for accreditation survey submissions.
• Ensure projects are completed on time and in scope.

Qualifications

Education Required

• Bachelor’s degree or an equivalent combination of education, training, and experience in a related field.
• Healthcare experience; preferably within a managed care organization.

Preferred/Desirable

• Master’s degree in a related field.

Experience

• 2 years of experience working in a healthcare environment.

Preferred/Desirable

• 1 year of HEDIS measure technical specifications, Quality, Auditing, or accreditation experience.
• CPHQ or other quality designation.
• Experience working in quality.

Certification Or Conditions Of Employment

• Pre-employment background check.

Competencies, Skills, And Attributes

• Ability to facilitate process improvement efforts.
• High proficiency in Microsoft Office including Word, Excel, PowerPoint, and Visio.
• Strong ability to foster relationships and build consensus; strong interpersonal skills.
• Ability to lead cross-functional groups, interact will all levels and areas of the organization, and interact with both clinical and non-clinical teams or individuals.

Working Conditions And Physical Effort

• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees.