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In addition, our in house Credentials Verification Organization, CREDENT, has been certified by the National Committee on Quality Assurance (NCQA) since 2001. We have earned the trust of medical professionals and facilities alike with our dedication to quality and ongoing satisfaction.
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Clinical Trainer and Quality Assurance Specialist serves as a subject matter expert to ensure DS system clinical staff (MA, LPN,) are effectively onboarded and maintain current evidence based clinical competencies necessary for compliance with NCQA, State/Federal and other applicable regulations.
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Educates providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Under general guidance form Senior Quality Practice Advisors and management, educates community physician and small provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements.
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Recently, St. Luke’s Cancer Center has received five awards from the National Committee for Quality Assurance (NCQA), a private, nonprofit organization dedicated to improving health care quality.
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Work with Senior leadership to support certification and accreditation processes with National Committee for Quality Assurance (NCQA)Serve as an expert in the administration and maintenance of credentialing and provider data management systems, including the Council for Affordable Quality Healthcare (CAQH), Credentialing System and proprietary claim systems.
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Assists in scanning correspondence and paper medical records and conducting quality assurance and quality audits, if requested. Assists clinic in meeting goals related to maintaining required government programs, such as NCQA and Meaningful Use programs.
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Comply with all regulatory and quality agency standards including: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Services (DHS), and accreditation bodies’ standards such as the National Commission of Quality Assurance (NCQA) as it relates to care management activities.
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1] HEDIS Certified Measures® is a registered trademark of the National Committee for Quality Assurance (NCQA). The Auditor, Sr. is a primary contributor to the Audit department's work that spans the broad spectrum of healthcare performance measurement projects at HSAG. Driven by intellectual curiosity and a passion for healthcare quality, this position performs-under supervision-healthcare auditing, data validation, and performance measurement projects through various stages including implementation, day-to-day operations, audit support, evaluation, and reporting.
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The position supports the functions related to quality improvement activities inclusive of quarterly reports that demonstrate health care outcomes in comparison to targets or national averages/percentiles published by recognized organizations such as National Committee for Quality Assurance (NCQA) and Certified Health Coach (CHC.
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Performs all assigned tasks in accordance with UPHP plans, policies, and procedures; National Committee for Quality Assurance (NCQA) standards; and all regulatory requirements. Performs care management duties to assess, plan, and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
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Accrediting bodies include, but not limited to, the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), National Committee for Quality Assurance (NCQA) that promotes Healthcare Effectiveness Data and Information Set (HEDIS) metrics, Utilization Review Accreditation Commission (URAC), and the Joint Commission (TJC.
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Staffed by the faculty, fellows and residents from two nationally ranked medical schools, Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth), Harris Health is the first healthcare system in Houston to receive the prestigious National Committee for Quality Assurance (NCQA) designation for its network of patient-centered medical homes, and both LBJ and Ben Taub Hospitals earned the ANCC Magnet Designation in 2020.
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SAC Health System is recognized as a Level-3 Patient-Centered Medical Home by the National Committee for Quality Assurance (NCQA). SAC Health System is the largest specialty-based and teaching health center (THC) FQHC in the nation.
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Applies advanced knowledge of regulatory and accreditation standards such as The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA) to ensure continued compliance in all matters pertaining to professional staff services.
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Serves as medical resource for quality improvement and National Committee for Quality Assurance (NCQA) and Health Plan Employer Data and Information Set (HEDIS) initiatives.
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