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Demonstrates knowledge, proficiency and compliance with regulatory requirements including, but not limited to: JCAHO, NPSG, Department of Health, HEDIS, PET and contractual obligations. Demonstrates knowledge, proficiency and compliance with regulatory requirements including, but not limited to: JCAHO, NPSG, Department of Health, HEDIS, PET and contractual obligations.
$38.5 - $44 depends on experienceFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Demonstrates knowledge, proficiency and compliance with regulatory requirements including, but not limited to: Joint Commission, NPSG, Department of Health, HEDIS, PCMH, QI and other contractual obligations.
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Working knowledge of IC, DHS, DMHC, NCQA, and CMS Standards. Review claim/referral appeals and unauthorized claims, forwarding them for medical director/UMC review and determination when appropriate.
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The Quality Improvement Specialist will be responsible for assisting the Quality Management Director in supporting the management of the corporate Quality Assurance Program and the Quality Improvement Program by interpreting and implementing quality assurance standards according to the Joint Commission, CLIA, OSHA NCQA and other relevant professional entities.
$26.44 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Knowledge of regulatory and certification requirements and their impact on the organization such as CMS, HCA, HEDIS, CAHPS, and NCQA. Have a minimum of two (2) years of experience in use of care management workflow systems; NCQA standards; and experience meeting with, and presenting to, organizations (required.
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Experience with HEDIS reporting desired. Responsible for maintaining and updating the GE/Centricity/IDX Managed Care Application (MCA) module for US Family Health Plan's managed care line of business: builds fee schedules, provider and vendor dictionary entries, and plan benefits and exclusions.
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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.
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Must have knowledge of and experience in coding with both CPT and ICD-9 and ICD-10. Assists with health plan utilization management reporting for the organization. Experience with GE/Centricity/IDX healthcare software application desired.
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Knowledge of Medicare Advantage plan mechanics and functional process including open enrollment, HEDIS, AWVs, HCCs, RAF scoring. Certified Risk Adjustment Coder (CRC) through AAPC desired. This may include outpatient treatment, professional and/or limited inpatient medical services, according to ICD-10 CM coding guidelines and risk adjustment model regulations.
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Provides oversight and support for the management of multi-faceted pharmacy government programs to reduce pharmacy spend, total cost of care, improve Star and HEDIS scores, and improve health outcomes, Support programs from evaluation through implementation and value realization.
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The Market Director also serves as the risk manager for the local market plan and, overall, is responsible for the clinical performance of the market, including HEDIS / Stars ratings, admissions per 1k, documentation and coding accuracy, medication therapy management (MTM) review rates, and more.
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Awareness of NCQA requirements, CMS guidelines, Medicaid/Medicare contracts and benefit systems is. Implements HEDIS measure campaigns and other quality initiatives to ensure the highest standards of care and to promote the improvement of care management and delivery.
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Knowledge of the Healthcare industry including physician practices, market access, insurance, managed care, organized delivery systems, STARs/HEDIS, Value based care and risk adjustment models. Knowledge of the Healthcare industry including physician practices, market access, insurance, managed care, organized delivery systems, STARs/HEDIS, Value based care and risk adjustment models.
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2 or more years’ experience in NCQA/HEDIS, Value-based contracting, Quality Improvement required. A friendly and family friendly city that puts water, mountains, skiing, hiking and whale watching within easy reach, the greater Seattle area is also a dynamic technology and innovation hub, and home to world-leading medical facilities and research.
$95.55 - $139.89 an hourFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Experience completing HEDIS measure validations, knowledge of HEDIS software tools, and working with NCQA on HEDIS measure questions. It will be responsible for working with management and peers on the end-to-end HEDIS submissions for a grouping of contracts, audit activities, benchmarking, testing, measure validation, IDSS/PLD submission, state-required reporting, and health plan liaison.
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ncqa hedis jobs in Seattle, WA
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