Accreditation Specialist -PCHP

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day.

Primary Purpose

The Accreditation Coordinator is responsible for ensuring that PCHP maintains compliance with all relevant state, federal, and accreditation standards, including those set by the Texas Health and Human Services Commission (HHSC), Centers for Medicare & Medicaid Services (CMS), and the National Committee for Quality Assurance (NCQA).

Minimum Specifications

Education

• Bachelor's degree in healthcare administration, Public Health, or a related field.

Experience

• Minimum of 3 years of experience in healthcare accreditation, regulatory compliance, or quality improvement, preferably in a Medicaid or managed care environment.
• Minimum of 2 years of experience with NCQA Accreditation.
• Experience with NCQA accreditation and familiarity with Texas Medicaid regulations strongly preferred.

Equivalent Education and/or Experience

• Seven (7) years of experience in a comparable position working in Texas Medicaid, Medicaid, or a Medicaid managed care organization may be considered in lieu of a degree.

Skills or Special Abilities

• Strong understanding of accreditation standards (NCQA, CMS) and Medicaid regulatory requirements.
• Excellent organizational and project management skills, with the ability to manage multiple tasks and deadlines.
• Strong analytical skills and attention to detail, with the ability to interpret and apply complex regulatory guidelines.
• Effective communication and collaboration skills, with the ability to work across departments and interact with internal and external stakeholders.
• Proficiency in Microsoft Office Suite and experience with healthcare data systems (e.g., HEDIS platforms, quality reporting tools).

Responsibilities

• Work closely with the Quality Improvement, Compliance, Health Services, Member Services, Provider Relations, Appeals and Grievances, and IT teams to ensure all departments align with accreditation standards and processes.
• Facilitate training and educational sessions for internal staff and providers on accreditation standards, processes, and best practices.
• Track and monitor key performance metrics related to accreditation standards to ensure the health plan consistently meets or exceeds expectations.
• Integrate health literacy principles into all communication, including that of members and providers.
• Prepare and submit comprehensive reports and updates to internal leadership, quality committees, and external regulatory bodies as required.
• Support PCHP's readiness for new accreditation or re-accreditation processes by identifying potential risks and recommending proactive measures to mitigate them.
• Collaborate with the Quality Improvement team to develop and implement strategies that improve performance metrics related to accreditation, including HEDIS, CAHPS, and other quality measures.
• Assist in developing and implementing quality improvement initiatives that address gaps in care, enhance service delivery, and ensure regulatory compliance.
• Support strategies that meet clinical, quality, and network improvement goals.
• Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
• Regularly review and analyze changes in accreditation standards (e.g., NCQA, CMS, HHSC) and communicate these changes to relevant departments to ensure continuous improvement and compliance.
• For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.
• Ensures work is carried out in compliance with regulatory and accreditation standards and contractual requirements.
• Supports Accreditation coordination of all activities, including NCQA, HHSC, and CMS standards, ensuring ongoing compliance with required guidelines.
• Supports efforts to prepare for and manage accreditation reviews, audits, and surveys, ensuring all documentation and materials are accurate, complete, and submitted on time.
• Support developing and implementing corrective action plans (CAPs) for identified deficiencies, ensuring timely resolution and compliance with accreditation and regulatory requirements.
• Maintain accurate records and documentation related to accreditation activities, including audit findings, corrective action plans, policies, and procedures.
• Promotes and supports a culturally welcoming and inclusive work environment.
• Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
• Adheres to organizational policies, procedures, and guidelines.
• Completes assigned training, self-appraisal, and annual health requirements timely.
• Adheres to hybrid work schedule requirements.
• Attends required meetings and town halls.
• Recognizes and communicates ethical and legal concerns through established communication channels.
• Demonstrates accountability and responsibility by independently completing work, including projects and assignments, on time and providing timely responses to requests for information.
• Maintains confidentiality at all times.
• Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.