For your career. And for health. When you join Kaiser Permanente, you not only build a rewarding career—you impact the future of health care. The nation’s leading nonprofit integrated health plan, Kaiser Permanente is supported by the professionals who build our systems, strengthen our facilities, and shape our future. Join us and take a stand for your future in Rockville, Maryland.
Quality Appeals Analyst
If your answer to the below questions is “YES”, this position is for you!
Have you written policies, procedures, and work instructions and managed these documents within a document controlled quality system?
Have you used quality tools to help improve performance?
Have you performed audits to assess compliance to standards?
Have you provided analysis, solved quality problems and worked on quality improvement projects? Have you assisted in preparing an organization for an external audit?
In this role, you will be accountable for ensuring compliance with standards set forth by the National Committee for Quality Assurance (NCQA), Center for Medicare and Medicare Services (CMS), Maryland Health Choice Program, State of Virginia Medicaid, and other State and Federal regulations and laws as it relates to appeals, complaints, grievances, and regulatory inquiries provider requirements such as assessment of geo-access and network adequacy; provider compliance newsletter; updating and distribution of provider manuals; monitoring of provider appointment access; compliance requirements for physician and hospital directories.
At least three years of experience working in health care quality
At least five years of work experience in health care
At least three years of experience auditing compliance to NCQA, Medicare, or Medicaid standards
A bachelor’s degree or four years of experience in a directly related field with a high school diploma or GED; a master’s degree in health administration or another health care related field preferred
Experience with CMS, Office of Personnel Management (OPM), Maryland Health Choice, Virginia Medicaid, and the Mid-Atlantic region’s State regulations governing heath care organizations preferred
Meticulous attention to detail with business writing and presentation skills and the ability to write clear concise reports
Six Sigma certified preferred
Strong analytical skills and the ability to interpret data
Knowledge of the Health Plan’s Appeals and Grievances policies and procedures preferred
Durable Medical Equipment (DME) experience preferred
Strong project management experience
Strong proficiency in Microsoft Visio Excel, Word, and PowerPoint
For immediate consideration, please visit http://jobs.kp.org for complete qualifications and job submission details, referencing job number 591832.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
This position supports Kaiser Permanente’s code of conduct and compliance by adhering to all laws and regulations, accreditation and licensure requirements, and internal policies and procedures.
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As America's largest nonprofit health plan, serving over 9 million members in nine states and the District of Columbia, we're driven by the needs of our patients and our responsibility to the communities we serve. We recruit high-caliber individuals and provide them with a positive work environment, outstanding facilities and resources, competitive wages, and exceptional benefits. If you believe q...uality of care and quality of life go hand in hand, this is the place to put your beliefs into practice.