Women's Health Arizona · 13 hours ago
Quality Coordinator
Phoenix, AZ
Full-time
Onsite
Mid LevelWomen's Health Arizona is dedicated to enhancing the quality of care for women, and they are seeking a Quality Coordinator to oversee quality incentive and compliance programs. The role involves interpreting regulatory requirements, establishing internal standards, and collaborating with various departments to ensure compliance and optimize quality outcomes.
Health CareNutritionWomen's
Responsibilities
Collaborate with Portal Access Managers to facilitate seamless communication and coordination with insurance payors
Establish standards and governance for payor portal access and data submission requirements
Oversee HEIDIS audit strategy and determine audit readiness standards; data validation requirements, and corrective action plans focusing on women's health quality metrics
Analyze audit outcomes and determine appropriate organizational response and remediation strategies in partnership with leadership
Interpret requirements related to BCBS and other insurance audits, and establish internal standards, timelines, and submission expectations to ensure compliance
Own and manage Value-Based Care (VBC) and pay-for-performance metrics, including accountability for data integrity, submissions, timelines, and performance outcomes
Establish quality measures specific to women’s health, including performance metrics, reporting frameworks, and correction actions to address identified gaps
Establish standards for consent forms pertinent to women's health services and approve updates to consent templates to ensure regulatory compliance
Serve as the quality and compliance subject matter owner on quality committees, and advise on regulatory and quality risk
Oversee chart audits related to Advance Beneficiary Notices (ABNs), surgical procedures, and appropriate consent documentation by establishing audit methodology and validation standards to ensure regulatory compliance
Ensure compliance with documentation standards and regulatory requirements
Establish and approve standards for SOPs related to consent processes and quality standards
Oversee MICA audits, including audit readiness and determination of corrective action plans
Direct various departments, including clinical staff, to execute quality and compliance requirements in alignment with established standards and timelines
Guide cross-functional execution of new quality initiatives, updates to policies, or procedures impacting women's health services
Qualification
Required
Bachelor's degree in healthcare administration, nursing, or a related field; a Master's degree is a plus
Previous experience in quality assurance, auditing, or a similar role, preferably within a women's health setting
Familiarity with healthcare regulations, quality metrics specific to women's health, and auditing processes, including HEIDIS and insurance audits
Excellent analytical skills with a high attention to detail and problem-solving capabilities
Strong communication skills to effectively present findings and collaborate with multidisciplinary teams
Proficiency in healthcare data analysis tools and quality management software
Demonstrated ability to exercise independent judgement and make decisions impacting organization quality performance, compliance posture, and financial outcomes
Company
Women's Health Arizona
With Women’s Health Arizona, women come first—always.
Founded in 2006
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase