Title: Quality Auditor
Location: Remote
Duration: 5 months
Client: Healthcare

Responsibilities:

• Conduct on-site reviews at participating provider offices to assess the environment, quality of physicians' medical records, and compliance with documentation standards.
• Prepare appropriate documentation to summarize on-site findings with physicians, provide education, and discuss opportunities for improvement.
• Provide data support services to facilitate the process and analyze trends/patterns for quality improvement and health management.
• Assist the Quality Management department with various special projects and focused clinical studies.
• Perform related tasks or special studies as requested.
• Assist in training internal staff, providers, and vendors on programs and audit standards, both on and off-site.
• Serve as an in-house representative and project lead for state audits. Analyze audit findings.
• Produce various reports as requested.
• Coordinate and manage the Corrective Action Plan (CAP) process for assigned audit types.
• Conduct reaudits to ensure prior deficiencies were addressed.

Required Skills:

• Registered Nurse
• Knowledge of managed care principles.
• Knowledge of medical terminology.
• Knowledge of PCs and related software.
• Prefer knowledge of URAC accreditation standards and HEDIS principles.
• Prefer knowledge of health management or patient education.