Accreditation Specialist

Why Choose Jefferson Health Plans?

We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.

Perks of JHP and why you will love it here:

• Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing 
• Flextime and Work-at-Home Options
• Benefits & Wellness Program including generous Time Off 
• Impact on the communities we service 

We are seeking a talented and enthusiastic Accreditation Specialist to join our team!

The Accreditation Specialist is responsible for assisting the Accreditation Manager in developing and implementing processes to support ongoing compliance/readiness for all National Committee for Quality Assurance (NCQA) Accreditation surveys.

As the Accreditation Specialist, your daily duties may include: 

• Interface with internal and external clients, committees, and departments in the review of data and in the implementation of appropriate interventions to effect improvement.
• Maintains knowledge of company policies and procedures to ensure compliance and support of standards in all levels of government (Local, State & Federal). 
• Mock File Reviews for Case Management, Medical and Pharmacy Denials, Appeals files, Credentialing and Recredentialing files
• Workplan Updates (Health Plan and Health Equity)
• Report Template creation and updates to template language with new/updated standards for both Health Equity and Health Plan Surveys
• Crosswalk of policy and standard changes (NCQA), annually
• Serve as subject matter expert regarding evaluating, interpreting and summarizing NCQA standards, accreditation requirements, report writing, policies, etc.
• Document preparation including bookmarking
• Upload IRT (NCQA) under the direction of the Accreditation Manager
• Conduct audits, identify training and communication needs
• Conduct trainings as needed
• Identify Gaps in evidence and compliance
• Performs all other tasks that may be required for position.

Qualifications

• BA/BS degree preferably in health/business administration or 5 years of relevant experience
• Three to five years progressive health care experience including accreditation compliance
• Successful NCQA Accreditation process completion and continuous process improvement experience is highly preferred

 Skills, We Value:

• Strong interpersonal skills, oral and written communication, and presentation skills. 
• Demonstrated ability to drive process improvement and quality within a team environment. 
• Strong quantitative, qualitative, and analytical skills,
• Process and project management ability.
• Proficiency in Microsoft Office products