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Enrollment / Eligibility Specialist
Doral, FL
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Quality and Accreditation Specialist ttg Talent Solutions - 3.6 Doral, FL Job Details Full-time $25 - $30 an hour 1 day ago Qualifications Spanish Spreadsheets English State healthcare regulations High school diploma or GED Health insurance knowledge Data-driven problem-solving Productivity software Data analytics technologies Quality assurance experience within healthcare Full Job Description Quality and Accreditation Coordinator
LOCATION
Doral, FL
SCHEDULE
: Monday-Friday, 40 hours per week. Schedule may vary based on business needs, including weekends, holidays, and overtime as needed.
TYPE OF CONTRACT
Temp to perm
PAY RATE
: $25.00-$30.00 per hour
Description:
ttg Talent Solutions is seeking a detail-oriented Quality and Accreditation Coordinator to support quality improvement, regulatory compliance, and accreditation activities within a highly regulated healthcare environment. This position works closely with quality leadership to coordinate quality programs, monitor performance measures, maintain required documentation, and support health plan accreditation activities. The role also collaborates with internal departments to help maintain compliance with applicable federal, state, CMS, and NCQA health plan accreditation requirements. The ideal candidate brings managed care or health plan experience, strong analytical abilities, excellent attention to detail, and the ability to translate data into meaningful information that supports quality improvement and organizational decision-making.
Key responsibilities include:
Review and analyze data involving claims, authorizations, grievances, appeals, case management, network adequacy, membership composition, and other quality-related areas. Assist with Quality-of-Care (QOC) investigations, Quality Improvement Committee (QIC) preparation, monitoring, and auditing activities. Support the preparation and organization of evidence files and required documentation for NCQA health plan accreditation surveys. Collect reports used to measure and benchmark performance against NCQA, CMS, and internal business objectives. Help ensure data and quality reporting are accurate, reliable, complete, and delivered in a timely manner. Collect performance indicator reports and benchmarking narratives for leadership review and performance improvement recommendations. Monitor quality performance, outcomes, and metrics to help identify opportunities for targeted process improvement initiatives. Prepare summaries and interpretations of reports and follow up on assigned action items related to projects, meetings, and committees. Assist with accreditation- and quality-related education for staff as needed. Support problem analysis associated with strategic planning initiatives. Identify and help resolve data integrity issues while monitoring the addition of new data, analytics, and reporting systems. Assist with interpreting and translating data into meaningful information for senior management, supporting informed decision-making and strategic planning. Assist with internal and external audits, including the preparation and organization of audit responses. Collect and maintain supporting documentation for Quality-of-Care concern investigations. Support departmental and organizational quality and performance objectives. Perform other related duties as requested, directed, or assigned.
REQUIREMENTS
High school diploma required; Associate's degree in Healthcare Administration, Nursing, or a related field preferred. Relevant professional experience may substitute for the educational requirement on a year-for-year basis. 2+ years of experience in managed care, Medicare, Medicaid, or a health plan environment. Bilingual proficiency in English and Spanish. Experience working with NCQA health plan accreditation standards. Knowledge of applicable federal regulations and healthcare industry standards. Strong analytical and problem-solving skills. Excellent written and verbal communication and documentation abilities. Strong attention to detail, particularly regarding data accuracy and integrity. Proficiency with Microsoft applications. Expert-level Microsoft Excel knowledge. At ttg, "We believe in making a difference One Person at a Time," ttg OPT. IND3
