Quality Coordinator

Major Responsibilities:
Oversees internal audit and continuous quality improvement activities, policies and procedures.
1)Contributes to the development of auditing and quality standards for timeliness, accuracy and method and source.

2)Maintains and tracks quality assessment information in collaboration with Manager and Supervisor, with recommendations for improvements. These would include monthly dashboard, analysis and corrective action plans, if needed.

3)Oversees reports and monitors turnaround time for analysis and action in collaboration with Manager and Supervisor.

4)Initiates audit and error reports for internal quality committee analysis and recommendation and actions,. Requests new reports from Data Analysts and tracks as appropriate.

5)Serves on the internal quality committee with Director, Manager and Supervisor.

6)Collaborates with Manager and Supervisor on types of reports to be generated by Data Analyst and assists in analysis for performance improvement.

7)Creates and maintains customer concern reports and acts on such as recommended by policies and quality committee.

8)Creates and maintains minutes of internal quality committee and maintains Credentials Committee and Staff Meeting minutes.

9)Performs ongoing monitoring of Medicare and Medicaid sanctions (monthly OIG match and IDPA reports), and State of Illinois licensing disciplinary actions (IDFPR monthly reports), reporting results to Compliance and internal credentialing customers and tracking results.

10)Audits initial applications of credentialing coordinators against database conventions and credentialing standards.

Responsible for contract maintenance and verifications from outside sources.
1)Initiates fee-based verification processes from outside sources such as those for nursing and podiatric certifications.

2)Maintains contracts for outside source verifications such as CertiFacts, AMA Masterfile, NTIS, National Student Clearinghouse, and criminal background check vendor.

3)Submits documentation of outside source payments and P-Card to Director for signature and payment.

4)Creates quarterly bills for internal customers and tracks payment receipt.

Manages data entry and oversees data convention adherence to assure clean and consistent data.
1)Runs regular data audit reports for expirables such as licensure, certification, DEA and insurance. Notifies appropriate associates with expirables requiring action (MSO managers for expired licenses, DEA, certification and insurance.) Collaborates with coordinators and sites to obtain relevant documentation and ensures appropriate udpates and scanning.

2)Initiates database changes and updates for office addresses, Tax ID, and other sensitive data changes.

3)Manages practitioner report card data including malpractice history data, NPDB CQ reports, and other data entry projects, reports and statistics.

4)Manages ongoing monitoring of Medicare/Medicaid and licensure sanction reporting.

Coordinates special data entry/change projects.
1)Provides administrative support to Director, Manager and Supervisor in carrying out departmental activities including special projects.

2)Contributes to continuous review of department policies and procedures

Education/Experience Required:
• Associate Degree or equivalent in business or health related field. • 5-6 years experience in credentialing within an acute care or managed care environment.

Knowledge, Skills & Abilities Required:
• PC Skills (word processing, data entry, email, etc.) • Access, Excel, Word and PowerPoint skills preferred. • Scanning equipment, FAX, copier, etc.
• CPCS certified or eligible to sit for exam.

Physical Requirements and Working Conditions:
• Local travel • Experience working with physicians • Ability to sit for extended periods • Excellent attendance and punctuality record • Ability to communicate verbally • Ability to use a computer and enter data for extended periods • Ability to organize and professionally manage demanding workload • Assertiveness/political intuitiveness • Demonstrated team player and self-motivated • By virtue of its nature, the job is highly stressful and demanding

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.