Coordinator - Quality Systems

Date: Sep 22, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7774 

 

Position Summary/Position

 

Under the direction of the Quality Systems Management Team, the Quality Systems Coordinator is responsible for completing administrative functions and supporting departmental activities including: data management, research, data entry, quality control, report generation and analysis, adherence to established departmental workflows. The Quality Systems Coordinator exercises independent judgment to ensure appropriate escalation protocols when trends or deficiencies are identified.

Major Functions (Duties and Responsibilities)

 

1. Perform  a  broad  range  of  administrative  duties,  using  initiative  and  judgment  in  handling confidential and time sensitive information.
2. Responsible for tracking, monitoring and managing incoming data from physicians, audits, and internal process supporting all HEDIS, Risk Adjustment and Quality activities.
3. Perform research, data entry and quality control on key data sources following prescribed guidelines/protocols in support of IEHP’s regulatory reporting requirements including: HEDIS, Risk Adjustment and Quality activities.
4. Adherence to established departmental workflow protocol in areas, as assigned.
5. Generate standardized reports in support of departmental activities.
6. Exercise independent judgment and discretion in such tasks as scheduling appointments and answering telephone calls.
7. Establish and maintain effective working relationships with others throughout the organization.
8. Demonstrate a commitment to incorporate LEAN principles into daily work.
9. Quality Management responsibilities include:
    a. Provide administrative support to the Quality Management Nurses, including: scheduling appointments, requesting medical records or other documentation, research provider metrics, ensure complete and accurate data entry of facility site review and medical record review data.
    b. Track and enter key data elements to support Potential Quality Incidents (PQIs), support nurse directives to request and compile case documentation, ensure complete and accurate data entry and case documentation is maintained within the QM database, following departmental protocols.
    c. Provide administrative support to Corrective Action Plan (CAP) follow up activities, including drafting of letters, monitoring CAP timeframes and completion of CAP activities through case closure.
    d. Generate, review and escalate, as needed, weekly aging report to ensure compliance to regulatory case timeframes.
10. Quality Assurance responsibilities include:
    a. Support the development and testing of audit tools, including the creation of data dictionaries
    b. Use of audit tools to audit departmental activities
    c. Policy review support activities, including road mapping and redlining departmental policies
    d. Provide administrative support Credentialing and Peer Review Committee reports and memos.  These activities include gathering provider profile reports.
11. HEDIS responsibilities include:
    a. Coordinate HEDIS Improvement meetings, including agenda meeting, packets and minutes.
    b. Provide timely and accurate monitoring of all incoming tasks from Member Services, Care Management teams.  Research and respond to issues timely.
    c. Responsible for supporting IEHP’s supplement database needs including: data entry, research, quality assurance and reporting.
12. Specific Risk Adjustment responsibilities include:
    a. Provide timely feedback and education on inquiries into the Medicare team to both physician offices and internal team members.
    b. Perform  outbound  Member  calls  based  on  inquiries  submitted  by  our  Home  Assessment vendor(s) by working collaboratively with Member Services, Provider Services and Medical Services staff.
    c. Answer all HCC-related calls and facilitate the answering of questions that come into the Medicare team phone line.

Supervisory Responsibilities

Leading: Self

Experience Qualifications

 

Three or more (3+) years of administrative experience in an office environment, including use of Microsoft Office Suite. Demonstrate superior interpersonal and administrative skills commensurate with years of experience.

Education Qualifications

 

High school diploma or GED required.

Preferred Education

 

Associate's degree from an accredited institution preferred.

Drivers License Required

Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Knowledge Requirement

 

Understanding of and sensitivity to multi-cultural community.

Skills Requirement

 

Excellent communication and interpersonal skills. Strong organizational skills, typing 45 words per minute, proficient in Microsoft Word and Excel is essential applications. Experienced in data entry.

Abilities Requirement

 

Ability to multi-task to coordinate, prepare and monitor special projects and reports as required. Telephone courtesy. Ability to handle multiple tasks, strong written and verbal communication skills.  Strong attention to detail.  Ability to prioritize work to ensure adherence to task deadlines. Positive Attitude and ability to work in a team setting.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. 

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Sitting - CONSTANTLY
Lighting - CONSTANTLY
Indoors - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY

A reasonable salary expectation is between $45,884.80  - $55,993.60, based upon experience and internal equity

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles