Excellus Health Plan Inc.
Accreditation Compliance & Quality Administrator I/II/III- 012677 (Finance)
This position assesses new and existing non-clinical regulatory/accreditation requirements and is responsible for the research, interpretation and assurance of compliance. This position will identify all regulatory/accreditation requirements as they pertain to designated area i.e; utilization management i.e; Provider Relations, Credentialing, Provider Contracting, Provider File Maintenance, etc.
Ensures activities align with corporate goals of improving care and experience for members. Assesses compliance through various methods, including auditing and monitoring. Conducts root-cause analysis and recommends, initiates and oversees process improvement activities. Identifies compliance, accreditation and/or governance best practice opportunities, recommends process refinements/improvements. This position provides oversight and management of regulatory, accreditation, ethics and/or privacy requirements, implementation and monitoring of activities as they relate to specific area of focus to ensure compliance and meet corporate goals.
This position requires working in partnership with management and staff across various operational groups in a matrix environment.
Essential Responsibilities/Accountabilities:
All Levels:
Level I:
Level II (in addition to Level I essential responsibilities/accountabilities):
Level III (in addition to Level II essential responsibilities/accountabilities):
Minimum Qualifications
NOTE:
We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels:
Level I:
Level II (in addition to Level I minimum qualifications):
Level III (in addition to Level II minimum qualifications):
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The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.
Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
Non Manager