Accreditation and Quality Coordinator in Wilkes-Barre, Pennsylvania at Federal Hearings And Appeals

Accreditation Support

• Assist the Director with the coordination, implementation, and maintenance of organizational accreditations (NCQA, URAC, ISO) across the full lifecycle, from initial applications through renewals and reaccreditation.
• Coordinate with departments to ensure compliance with accreditation standards and maintain continuous audit readiness.
• Collect, validate, and maintain centralized evidence, documentation, and reports required for applications, audits, and renewals.
• Develop and maintain accreditation timelines, work plans, and tracking tools, and support the preparation and submission of applications, annual reports, and responses to accrediting bodies.
• Monitor changes to accreditation standards and regulatory requirements and communicate updates to the Director and relevant departments.
• Support internal audits, mock audits, and readiness reviews to identify documentation gaps, noncompliance, and improvement opportunities.
• Track departmental deliverables and assist with developing and monitoring corrective action plans for audit findings or compliance deficiencies.
• Serve as liaison between the Director, internal departments, and external accrediting organizations, as needed.
• Identify opportunities to streamline workflows, strengthen documentation practices, and improve organizational readiness.

Document Control

• Prepare, update, and maintain all controlled documents within FHAS’ Document Control System, ensuring compliance with current URAC, NCQA, and ISO requirements.
• Manage the document periodic review process.
• Produce and maintain a master list of all controlled documents.
• Provide quarterly policy and procedure updates to the Quality Management Committee (QMC).
• Control project documentation across multiple simultaneous projects, ensuring document control support for each.
• File all controlled documents in accordance with FHAS’ Record Retention Policy.
• Support internal and regulatory audits and inspections, and perform departmental compliance monitoring as directed by the Compliance and Ethics Committee.

Arbitration QA

• Perform quality assurance reviews of arbitration outcomes to ensure determinations are accurate, well supported, clearly written, and consistent with FHAS standards, policies, and decision-making guidelines.

• Review outcome letters and related communications for compliance with applicable CMS regulations, including required content, language, and timeliness.
• Evaluate the application of applicable standards, supporting rationale, and use of the case record in arbiter determinations.
• Identify errors, inconsistencies, and compliance gaps and communicate findings to the arbiter, QA & Training, and relevant departments.
• Provide feedback, recommend targeted training or coaching, and support corrective action plans to improve arbiter quality and compliance.
• Maintain audit-ready documentation of QA reviews, scoring, and findings, and support audits as required.
• Contribute to the development and maintenance of QA tools, review criteria, scorecards, and sampling methodologies.

• Minimum of 5 years of experience in healthcare accreditation, quality management, audit coordination, document control, or a closely related function.
• Hands-on experience supporting at least one accreditation, certification, or external audit cycle, including coordinating evidence collection, preparing submissions, tracking findings, and following corrective actions through completion. Experience with URAC, NCQA, or ISO is preferred; experience with all three is not required.
• Experience administering controlled documents, including version control, approval workflows, periodic reviews, document inventories, and records retention.
• Proficiency with Microsoft Word, Excel, and electronic document management or project tracking systems; SharePoint experience is preferred.
• Strong organizational, written communication, and follow-through skills, with the ability to manage competing deadlines, maintain accurate records, and handle confidential information.