Director, Quality Operations

Tecsa; Illinois; On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Competitive salary

Medical/Dental/Vision insurance

Employer-paid life insurance

Paid maternal leave

Paid parental leave

401(K) match

Paid time off

Employee assistance program

Job summary

Zing Health is seeking a Director of Quality Operations to lead HEDIS measurement initiatives, audits, and NCQA submissions. You will develop and execute targeted interventions to improve Stars performance, manage data abstraction, and educate providers on documentation and coding per NCQA guidelines.

Collaborating with leadership, you will ensure compliance with federal and state regulations, coordinate with the Provider Network, and drive the Quality Management Program and committee activities

Qualifications

• HEDIS reporting activities or Stars reporting experience.
• Experience overseeing HEDIS/Stars reporting and NCQA submissions.
• Knowledge of CMS Star Ratings, CAHPS, and Pharmacy measures.

Responsibilities

• Acts as SME for HEDIS measures, audits, and submissions.
• Develops interventions to improve Stars and HEDIS performance.
• Implements quality strategies and provider/member interventions.
• Administers enterprise quality and accreditation programs and audits.
• Ensures compliance with federal and state regulations.
• Manages NCQA submissions and data abstraction processes.
• Educates providers/IPAs on HEDIS documentation and coding.
• Collaborates with Provider Network to improve quality, risk adjustment, and operations.
• Develops and monitors Quality Management Program Evaluation and Work Plan.
• Leads QM committee functions and meetings.
• Performs related duties as assigned.

Skills

HEDIS experience

Medicare Stars ratings

Data analysis

Continuous quality improvement

Clinical-administrative data

Education

Bachelor’s degree in Healthcare/Public Health

Master’s degree preferred

Registered Nurse Licensure

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Microsoft PowerPoint

Job description

Company Overview

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

Description

Summary Description

The Director, Quality Operations is responsible for supporting the development and implementation of quality improvement interventions and audits. The Director acts as a subject matter expert on HEDIS measures including providing education on practices related to appropriate medical record documentation and appropriate coding. The Director will assist in resolving deficiencies impacting Zing Health plan’s compliance with State and Federal standards for HEDIS.

Essential Functions

• Acts as subject matter expert for The Healthcare Effectiveness Data and Information Set (HEDIS) measures, audits, and submissions.
• Develops and implements targeted interventions related to Stars performance including HEDIS, pharmacy measures, customer service and administrative measures.
• Implements key quality strategies, including initiation and management of provider, member and/or community interventions to achieve optimal health outcomes.
• Develops, documents, and administers enterprise quality and accreditation strategies, activities and programs including the auditing and implementation processes.
• Collaborates with leadership to ensure compliance with federal regulations, and health plan state regulations.
• Develops and monitors the supplemental HEDIS data file and abstraction processes.
• Leads documentation and evidence gathering, citation, and submission of NCQA submissions, including Health Plan and SNP submissions.
• Advises and educates Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-10 CPT coding in accordance with NCQA requirements
• Collaborates with Provider Network to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters)
• Develops annual Quality Management Program Evaluation and Quality Management Work Plan; monitors Quality Management work plan progress at regular intervals and reports to QM Committee.
• Facilitates quality improvement committee functions and meetings.
• Performs other related duties and/or projects as assigned.

Requirements

Position Qualifications

Education/Experience

• Bachelor’s degree in Healthcare, Clinical Profession, or Public Health
• Three years direct experience leading or performing HEDIS reporting activities or five years management experience, including experience overseeing HEDIS and Stars reporting.

Preferred Qualifications

• Master’s degree preferred
• Registered Nurs Licensure

Required Skills

• Must exhibit an intermediate level of expertise in the following:
• Healthcare Effectiveness Data and Information Set (HEDIS) experience
• Medicare Stars ratings including HEDIS, CAHPS, and Pharmacy measures
• Data analysis and continuous quality improvement processes
• Demonstrated experience aligning data sources to HEDIS specifications for proper extract requirements
• Experience integrating clinical data with administrative data and developing supplemental data sets

Additional Required Skills

• Strong knowledge of healthcare delivery
• Excellent Communication skills — Listening, speaking, and writing.
• Personal management skills — Plan and manage multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments.
• Teamwork —ability to work well with one or more groups.
• Interpersonal effectiveness — Relate to co-workers and build relationships with others in the organization.
• Strong work values — Dependability, honesty, and a positive attitude.

Technical Skills

• Required intermediate Microsoft Excel
• Required intermediate Microsoft Word
• Required intermediate Microsoft Outlook
• Required intermediate Microsoft PowerPoint

Member-centric Impact Statement

Leads enterprise-wide quality strategy focused on CMS Star Ratings, HEDIS performance, CAHPS improvement, and quality interventions. Priorities include measure gap closure, provider collaboration, medication adherence, and member experience initiatives. Measurable impact includes Star Ratings improvement, increased bonus revenue, higher preventive screening rates, improved CAHPS scores, and enhanced quality audit outcomes.

Benefits

• A competitive salary based on the market
• Medical, Dental, and Vision
• Employer-Paid Life Insurance
• Paid Maternal Leave
• Paid Paternal Leave
• 401(K) match up to 4%
• Paid-Time-Off
• Employee Assistance Programs
• Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.

Zing Health is committed to being an Equal Opportunity Employer. This means the company ensures all employment decisions, including hiring, promotion, compensation, and benefits, are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other legally protected characteristic. Zing Health strives to create a diverse, inclusive, and respectful workplace, providing equal access and opportunities for all employees and applicants. The organization actively promotes a culture of fairness and non-discrimination, supporting the personal and professional growth of every team member.