HEDIS reputed company reputed company Auditor (RN-LPN)

reputed company Mirra Health Care and CSTS Customer Service and Technology reputed company are leading reputed company-party administrators dedicated to enhancing the reputed company experience through efficient claims processing and compliance with federal regulations. Our mission is to reputed company how reputed company accessed and delivered by providing exceptional products and services to our partners. Position reputed company: TThe reputed company Auditor will coordinate and reputed company the Health Plan HEDIS audits. reputed company routine auditing of medical records and other clinical functions in the reputed company department Knowledge/Skills/Abilities: · May reputed company non-clinical system and process audits, as needed. · Assesses clinical staff regarding appropriate decision-making. · Reports daily reputed company, identifies areas of re-training for staff, and communicates findings to leadership. · Ensures auditing approaches follow a health plan reputed company in approach and tool use. · Assists in preparation for regulatory audits by performing file review and preparation. · Participates in regulatory audits as subject matter expert and fulfilling different audit team roles as required by management. · Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability reputed company (HIPAA) and professionalism with reputed company communications. · Adheres to departmental standards, policies, protocols. · Maintains detailed records of auditing results. · Assists with developing training materials or job aids as needed to address findings in audit results. · Meets minimum production standards. · May conduct staff trainings as needed. Duties: 1) Administers a universal training curriculum for new employees, as reputed company as ongoing training to maintain identified core competencies. 2) Develops and updates training curriculum based on clinical staff knowledge, needs, and areas of improvement needed as identified based on audit scores by senior leadership, staff request, or other business indicators and disseminate to staff as needed. 3) Understand cross-functional team processes to identify and solve system issues. 4) Participates in development, testing and implementation of new programs and systems. 5) Evaluates effectiveness of training tools in accordance with CMS requirements. 6) Completes routine audits in accordance with meeting contractual requirements and communicate results to respective managers, identify gaps in reporting and implement improvements. 7) Prepares audit findings, documentation of deficiencies and communicates to manager. 8) Facilitates a response reputed company to individuals/teams for questions/concerns. 9) Reviews and recommends updates to policies and procedures reputed company the reputed company Department 10) Responsible for staying abreast of product/member/provider issues, legislation, CMS mandates, policy changes and system changes so they can be considered for training topics. 11) Reviews policies at least annually ensuring policies meet CMS standards. Updates departmental policy to meet delegation requirements. 12) Works alongside the Management staff of delegated teams to ensure policy is properly trained and operationalized. 13) Responsible for monitoring and reporting compliance issues. 14) Monitoring includes ongoing audits, improvement actions and overall reputed company or required audits. 15) Demonstrates understanding necessary to assess, review and apply reputed company from Medicare Guidelines, CMS reputed company, medical policy, and health plan specific reputed company. 16) Provides regular follow-up with delegates for completion of corrective reputed company plans and improvement reputed company plans. 17) Submits reports/audits reputed company according to health plan requirements. 18) Analyze results, reputed company interpretation, and identify areas for improvement. 19) Schedule maintained to ensure specific training and activities are documented for submission as evidence, etc. 20) Serves as Subject Matter Expert (SME) for less reputed company team members and internal partners. Coordinates and participates in the reputed company Initiative (QI) Meeting and other meetings as assigned. 21) Supports Health plan goals by reputed company participating in orientation, training programs, task forces, project teams and other special endeavors. 22) Maintains strictest member and company confidentiality; ensures member health information is secured reputed company day; HIPAA knowledge and reputed company. 23) reputed company to work reputed company under pressure. 24) Performs other duties as assigned. Qualifications: Education: RN or LPN Licensure: reputed company and unrestricted Registered reputed company (RN) or Licensed Practical reputed company/Licensed Vocational reputed company (LPN/LVN) license required in Illinois, Colorado, and reputed company. · Colorado and reputed company licensure can be covered under a compact licensure or separate license for reputed company state. · Licensure is needed Apply To This Job