NCQA Quality & Accreditation Specialist – Onsite

Solis Health Plans, Inc.; Florida; On-site; USD 52,000 - 62,000; Full time

Job summary

Solis Health Plans, Inc. is seeking a Quality Accreditation Coordinator to support quality improvement, regulatory compliance, and NCQA accreditation activities in a busy Doral office.

You will review data across claims, authorizations, grievances, and performance measures; prepare evidence for NCQA surveys; and collaborate with internal teams to ensure data accuracy and timely reporting. This full-time, onsite role requires attention to detail, Excel expertise, strong communication, and the

Qualifications

• 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.
• 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 byDirector 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.

Skills

Data analysis

Excel

Bilingual English/Spanish

Regulatory compliance

NCQA accreditation standards

Documentation

Education

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

Tools

Microsoft Office

Job description

Solis Health Plans, Inc. is seeking a Quality Accreditation Coordinator to support quality improvement, regulatory compliance, and NCQA accreditation activities in a busy Doral office.

You will review data across claims, authorizations, grievances, and performance measures; prepare evidence for NCQA surveys; and collaborate with internal teams to ensure data accuracy and timely reporting. This full-time, onsite role requires attention to detail, Excel expertise, strong communication, and the