Director, Quality Operations

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

• SUMMARY DESCRIPTION:

The Director, Quality Operations is responsible for supporting the development and implementation of quality improvement interventions and audits. The Director acts as a subject matter expert on HEDIS measures including providing education on practices related to appropriate medical record documentation and appropriate coding. The Director will assist in resolving deficiencies impacting Zing Health plan’s compliance with State and Federal standards for HEDIS.   

ESSENTIAL FUNCTIONS

• Acts as subject matter expert for The Healthcare Effectiveness Data and Information Set (HEDIS) measures, audits, and submissions. 
• Develops and implements targeted interventions related to Stars performance including HEDIS, pharmacy measures, customer service and administrative measures.  
• Implements key quality strategies, including initiation and management of provider, member and/or community interventions to achieve optimal health outcomes. 
• Develops, documents, and administers enterprise quality and accreditation strategies, activities and programs including the auditing and implementation processes. 
• Collaborates with leadership to ensure compliance with federal regulations, and health plan state regulations. 
• Develops and monitors the supplemental HEDIS data file and abstraction processes. 
• Leads documentation and evidence gathering, citation, and submission of NCQA submissions, including Health Plan and SNP submissions. 
• Advises and educates Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-10 CPT coding in accordance with NCQA requirements
• Collaborates with Provider Network to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters)
• Develops annual Quality Management Program Evaluation and Quality Management Work Plan; monitors Quality Management work plan progress at regular intervals and reports to QM Committee. 
• Facilitates quality improvement committee functions and meetings. 
• Performs other related duties and/or projects as assigned.