Accreditation Specialist III
Accreditation Specialist III
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Job Description
Lets do great things together!
About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.
Position Summary
The Accreditation Specialist III will plan and manage all project activities and tasks related to attaining Health Equity Accreditation (HEA) from the National Committee for Quality Assurance (NCQA) under the direction of the Supervisor Quality Operations and the Manager Quality Programs. The major purpose of this role is to identify risks toward HEA readiness and work collaboratively with relevant business areas to develop sustainable solutions. The Accreditation Specialist III serves as the primary liaison between the organization and external accreditation consultants and conducts all organizational training related to HEA and Health Plan Accreditation (HPA) in driving organizational awareness of accreditation. Key duties and responsibilities will include developing project work plans executing project tasks and deliverables and reporting project status to the Supervisor and Manager. Through effective project management of HEA the Accreditation Specialist III will support the entire organization in reducing health disparities and helping develop equitable solutions to healthcare issues.This is a fulltime WFH position.
Pay Range
$30.13 $41.28 hourly (depending on experience)
*Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
Please fill out an application on our company page linked below to be considered for this position.
Dental Vision Pharmacy Life & Disability
Required Skills Experience & Education:
- Bachelors degree or equivalent experience; masters degree in public health healthcare administration health equity or other related field preferred.
- Three 3 to five 5 years of experience in the healthcare insurance industry.
- Five 5 years of business experience in project management and/or project coordination roles.
- Two 2 to four 4 years of experience in quality improvement programs with experience in NCQA.
- Understands the relationship between NCQA Affordable Care Act (ACA) and Centers of Medicare and Medicaid (CMS) as it relates to specific NCQA Accreditation requirements.
- Experience in planning implementing and evaluating projects or programs related to advancing health equity and improving health outcomes at a population level.
- Strong analytical problem solving decision making organizational and detail orientation skills.
- Ability to work well under pressure with frequent interruptions and shifting priorities.
- Strong proficiency in projectrelated software including Microsoft Office Suite and Visio.
- Strong interpersonal and communication skills (both oral and written) with a customer service emphasis.
- Ability to be selfsufficient and innovative and to work both independently and as part of a team in a fastpaced environment on multiple projects.
- Ability to come to work on time and daily.
- Maintains confidentiality and projects a professional business image.
Primary Functions:
- Manages the HEA process for all required states and lines of business including all administrative tasks.
- Develops project workplans roadmaps and timelines to obtain HEA and shares all project details with the Accreditation Specialist I.
- Works with key department staff to plan and organize workload assignments monitor progress and coordinate changes in priorities and schedules to ensure work is completed in an efficient and timely manner.
- Determines risks and effective solutions for all projects and deliverables related to HEA. Tracks monitors and reports risks and solutions to Supervisor Quality Operations Manager Quality Programs and Executive Leadership when necessary.
- Effectively communicates project status goals and milestones to all levels of internal staff management vendors and external customers.
- Coordinates communication of information among Medical Quality Improvement Committee (MQIC) and serves as SME on HEA for organization.
- Ensures all crossfunctional teams are properly collaborating for timely report and policy and procedure completion.
- Creates and facilitates all HEA and HPA training workshops and materials collaborating with operational areas to expand knowledge and awareness of NCQA procedures.
- Acts as the Accreditation Teams primary liaison to the Accreditation Consultant. Works with and delegates items to external accreditation consultant as needed.
- Assists with all inquiries related to HEA and obtains answers to questions from business areas in a timely manner.
- Reviews edits and annotates all reports materials and policy and procedure evidence for all standard categories for HEA.
- Understands and communicates all changes to HEA standards and changes needed to occur to ensure compliance with HEA on an annual basis.
- Reviews all evidence and requests edits as needed from business areas. Communicates these to the Supervisor Manager and Accreditation Specialist I.
- Ensures Accreditation Team processes and practices are consistent with the overall project goals.
- Works with all areas of the health plan e.g. leadership senior management clinical network and quality improvement.
- Remediates all survey issues for HEA.
- Prepares presentations and materials to provide to Executive Leadership on behalf of Accreditation Team.
- Collaborates with Supervisor and Manager to accomplish final survey submission for HEA.
- Perform other duties as assigned.
Working Conditions &Contact with Others
- Office environment with extensive close PC and keyboard work constant sitting and phone work. Must be able to navigate multiple screens. Work in excess of 40 hours per week including evenings and occasional weekends to meet business need.
- Internally with all levels of staff and management across department lines. Externally with customers vendors IT contractors and thirdparty technical support.
Together we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race religion color age sex sexual orientation national origin marital status disability veteran status or any other status protected by law. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.
For more information regarding accommodations please direct your questions to Kristy Nehler & Danielle Baker via email.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
