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Strong understanding of healthcare quality measures, including NCQA HEDIS measures, measures derived from EHR and other standardized datasets, administrative data, and public health databases. Manage the process of NCQA certification for HEDIS measures, including data collection, submission, and validation.
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Knowledge of the Medicare Advantage STARS program and NCQA technical specifications. Required Certified Professional Coder (CPC-I) certification, Certified Risk Adjustment (CRC) coder AAPC certification, and Certified Professional Medical Auditor (CPMA) certifications from AAPC (to obtain CPMA within 120 days from date of hire, if applicant does not currently possess.
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Ensuring all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS, serving as internal auditor within the group. Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment.
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Leads initiatives to achieve recognition as Patient-Centered Medical Homes (PCMH) under NCQA standards. Responsible for achieving programmatic requirements with other entities and payors such as the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid services (CMS), and Central California Alliance for Health (CCAH.
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Promote timely access to appropriate and encompassing care in compliance with standards set forth through HRSA and NCQA. Its expanded mission has made it one of the nation's largest HIV/AIDS, lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) healthcare organizations.
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Adheres to all Corporate and Departmental policies and ensures all regulatory requirements such as DOH, CMS, Medicaid, and accreditation requirements such as NCQA , URAC and HEDIS functionalities are met or exceeded.
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You will participate in measure certification processes, such as the NCQA certification process for HEDIS measures. Understanding of quality measurement standards, regulations, and accreditation requirements, including NCQA, CMS, and other regulatory bodies.
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Familiarity with healthcare regulatory requirements, including NCQA accreditation standards and CMS quality reporting programs. Ensure compliance with NCQA standards and requirements for quality measurement and reporting.
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Bachelor's or Master's degree in Health Informatics, Statistics, Public Health, Epidemiology, or a related field. Statistical Software: SAS, R, Python. Data Visualization Tools: Tableau, Power BI, ggplot2 (in R.
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Proficiency in data manipulation, analysis, and visualization using tools such as SQL, Python, R, SAS, or similar. Business Intelligence Tools: Looker, Mode Analytics. This individual will play a key role in analyzing, coding, and interpreting quality measures from various data sources, standardized and non-standardized datasets such as EHR, MDS, OASIS, and claims.
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Certification in Healthcare Quality (e.g., Certified Professional in Healthcare Quality - CPHQ). Machine Learning Frameworks: TensorFlow, scikit-learn. We also honor and respect the needs of our Net Health family and staff, which is why we offer a work-from-anywhere environment and unlimited PTO. Our welcoming and collaborative culture paired with progressive benefits makes Net Health the ultimate career home.
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Our software and predictive analytics cover the continuum of care, from hospital-to-home, across various medical specialties. Collect, calculate, analyze and integrate data from diverse sources, standardized and non-standardized datasets such as EHR, MDS, OASIS, and claims.
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Programming Languages: Python, R. Database Management Systems: MySQL, PostgreSQL. Experience working with healthcare data sets and familiarity with data integration techniques and methodologies. Identify opportunities for process improvement, automation, and innovation in quality measurement and analytics.
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The manager collaborates with administrators, medical staff, and other disciplines to ensure alignment with evidence-based population health management practices (NCQA PCMH and Health Equity Accreditations.
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Experience working in a healthcare analytics or quality improvement role within a healthcare organization or consulting firm. A high-growth and profitable company, we help caregivers harness data for human health.
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