NCQA Quality & Accreditation Specialist

Solis Health Plans, Inc.; Florida; Vor Ort; USD 42.000 - 62.000; Vollzeit

Zusammenfassung

Solis Health Plans, Inc. is seeking a Quality and Accreditation Coordinator to support continuous quality improvement, regulatory compliance, and NCQA accreditation efforts.

The role partners with the Director of Quality Operations to coordinate programs, monitor performance measures, and maintain required documentation across departments. The coordinator will assist in preparing evidence for NCQA surveys, analyzing data for performance improvements, and ensuring timely, accurate reporting to

Qualifikationen

• HS Diploma 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 NCQA health plan accreditation knowledge or experience.
• 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.

Aufgaben

• Review and analyze data across claims, authorizations, grievances, appeals, case management, and related areas.
• Assist with QOC investigation, QIC prep, monitoring, and auditing.
• Support preparation of evidence files for NCQA accreditation surveys.
• Collect reporting for measurement and benchmarking of performance measures.
• Ensure data is accurate, reliable, and reported timely.
• Collect performance indicator reports and benchmark narratives for review.
• Assist with monitoring quality performance and proposing improvements.
• Prepare overviews and interpretation of reports; follow up on action items.
• Assist with accreditation and quality-related staff education.
• Assist with problem analysis for strategic planning initiatives.
• Resolve data integrity issues and oversee new data, analytics, and reporting systems.
• Assist with data interpretation for senior management decisions.
• Assist with internal and external audits and preparation of audit responses.
• Collect supporting documentation for Quality-of-Care investigations.

Kenntnisse

Data analysis

Problem solving

Communication

Documentation

Attention to detail

Excel

Microsoft Office

Ausbildung

HS Diploma

Associate's degree in Healthcare Administration, Nursing, or related field

Tools

Microsoft Office

Microsoft Excel

Jobbeschreibung

Solis Health Plans, Inc. is seeking a Quality and Accreditation Coordinator to support continuous quality improvement, regulatory compliance, and NCQA accreditation efforts.

The role partners with the Director of Quality Operations to coordinate programs, monitor performance measures, and maintain required documentation across departments. The coordinator will assist in preparing evidence for NCQA surveys, analyzing data for performance improvements, and ensuring timely, accurate reporting to