Quality Coordinator

Description

This role is essential to ensuring the effective ownership and oversight of quality incentive and compliance programs across Women’s Health Arizona. . The Quality Coordinator will interpret quality, payer, and regulatory requirements; establish internal standards; and direct cross-functional execution to ensure compliance, optimize incentive outcomes, and mitigate organizational risk.

Key Responsibilities:

Payor Portal Access Administrator:

• 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. HEIDIS Audits:
• 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. BCBS/Other Insurance Audits:

• 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.

Quality Measures and Leadership Feedback:

• Establish quality measures specific to women’s health, including performance metrics, reporting frameworks, and correction actions to address identified gaps.

Assistance with Consent Forms & Committee Participation:

• 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.

Chart Audits:

• 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.

Creation & Edits of Standard Operating Procedures (SOPs):

• 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.

Collaboration and Training:

• 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.

Work Environment:

This position involves working closely with healthcare providers, administrative staff, and insurance payors, fostering collaboration to enhance quality care in women’s health. Some travel may be required for audits and assessments.

Requirements

• 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.