About us:
Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was founded with a desire to provide a more personalized experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us!
POSITION IS ONSITE Mon-Friday, Bilingual in Spanish is required.
Full benefits package offered on the first of the month following date of hire including: Medical, Dental, Vision, 401K with a 100% company match! Our company has double in size and we have experienced exponential growth in membership from 2,000 members to over 10,000 members.
Join our winning Solis Team!
Must have NCQA work experience
Position Summary:
The Quality Coordinator is responsible for analyzing Medicare claims data to identify potential errors, non-compliance issues, and areas for improvement in patient care, ensuring adherence to regulatory standards, and collaborating with internal teams to implement quality improvement initiatives, all while maintaining patient privacy and confidentiality.
Essential Duties and Responsibilities:
- Review and analyze data across various areas, including claims, authorizations, grievances, appeals, case management, network adequacy, membership composition, and other related fields.
- 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 by Quality Director 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 training departmental Quality program requirements.
- 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 audits and preparation of audit responses.
- Collects supporting documentation to support review of Quality-of-Care concern investigations.
Qualifications and Education:
- HS Diploma required or Associate's degree in Healthcare Administration, Nursing, or related field.
- 2+ years of experience in managed care, Medicare, Medicaid, or healthcare setting.
- NCQA work experience required.
- Bilingual in English and Spanish.
- Relevant experience may substitute for the educational requirement on a year-for-year basis.
- 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.
What Sets Us Apart:
Join Solis Health Plans as a Quality Analyst and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!