Job description

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. Any other duties as required to ensure the Health Plan operations are successful.
10. Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.

11. 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.

12. 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. Major Functions (Duties and Responsibilities) Cont

13. 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.

14. 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. Preferred Experience Education Qualifications

High school diploma or GED required. Preferred Education

Associate's degree from an accredited institution preferred. Professional Certification Professional Licenses 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. Strong written and verbal communication skills. 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 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.
Position is eligible for telecommuting/remote work location model upon completing the necessary steps and receiving HR approval. The incumbent approved to telecommute may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs determined by IEHP leadership. Work Model Location Telecommute 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 and $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, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 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 stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.

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