QA Engineer responsible for validating products and maintaining automated tests in Agile environments. Collaborating with teams in Pune to enhance QA processes and track metrics.
BC
Hybrid NCQA Accreditation Analyst
Posted 6 months ago
About the role
- NCQA Analyst leading accreditation compliance activities, monitoring standards and collaborating with teams in a healthcare company. Responsible for audits and quality improvement initiatives.
Responsibilities
- Lead accreditation compliance activities including review and interpretation of the standards
- Monitor multiple areas' compliance
- Develop and implement quality improvement activities to improve compliance
- Maintain full three-year accreditation status and monitor NCQA processes/standards
- Conduct/participate in audits of areas to ensure compliance with NCQA activities
- Analyze audit results and make recommendations for improvements
- Prepare formal documentation of audits
- Present findings to relevant committees and monitor corrective action plans
- Provide HEDIS support for multiple departments
- Coordinate preparation of on-site audits conducted by external bodies
- Review medical records for coding validations
Requirements
- Bachelor's in a job related field
- 5 years of health insurance industry, audit/compliance/investigations, project management, or corporate level related experience
- If Master’s degree, required work experience is 3 years
- Ability to effectively communicate both verbal and in writing to all levels of the organization
- Knowledge/understanding of medical terminology and medical coding
- Excellent analytical or critical thinking and problem solving skills
- Ability to make sound decisions and work independently
- Ability to exercise confidentiality and discretion
- Excellent presentation skills with strong attention to detail
- Microsoft Office skills
Benefits
- Subsidized health plans
- Dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
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