Solis Health Plans · 2 hours ago
Quality Coordinator
Doral, FL, US
Full-time
Onsite
Entry Level
$25/hr - $30/hr
2+ years expSolis Health Plans is seeking a Quality Coordinator responsible for analyzing Medicare data to identify potential errors and areas for improvement in patient care. The role involves collaborating with internal teams to implement quality improvement initiatives while ensuring adherence to accreditation and regulatory standards.
Health CareHealth DiagnosticsPersonal Health
Responsibilities
Review and analyze data across various areas, including claims, authorizations, grievances, appeals, case management, network adequacy, membership composition, and other related fields
Assist with QOC investigation, QIC Prep, monitoring and auditing
Supports with NCQA renewal survey
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
Qualification
Required
HS Diploma required or Associate's degree in Healthcare Administration, Nursing, or related field
2+ years of experience in managed care, Medicare, Medicaid, or health plan setting
Bilingual in English and Spanish
Relevant experience may substitute for the educational requirement on a year-for-year basis
Knowledge of NCQA accreditation standards, 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
Company
Solis Health Plans
Solis Health Plans is a medicare firm that deals with healthcare solutions and plans.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Efrain Duarte
Chief Executive Officer
Michael Lynch
Chief Financial Officer
Recent News
2025-04-15
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