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Health Plan Auditor
healthcare topics and support the development of reports Required Qualifications Bachelor's degree in business, science, or healthcare-related field Minimum of 1 year of experience working with healthcare provider data Preferred experience with managed...care provider network adequacy monitoring Proficiency in Microsoft Word, Excel, and PowerPoint Experience in conducting internet researchMHPAEA Compliance Senior Professional
comprehensive MHPAEA compliance program Conduct regular risk assessments and represent the organization during MHPAEA-related external audits Required Qualifications Bachelor's degree or equivalent experience 3+ years of experience with Utilization Management..., Care Management, or Case Management 2+ years of experience with healthcare or insurance regulations Successful record of building and maintaining positive cross-functional relationships Ability to work independently and effectively allocate timeQuality Improvement Coordinator
projects Required Qualifications 1+ year of experience in a fast-paced health insurance environment Understanding of healthcare quality measures such as HEDIS, CMS, and NCQA Comprehensive knowledge of Microsoft Office Suite Experience in Medicaid managed...care Previous experience in meeting documentation and note-takingCalifornia Licensed DRG Audit SME
coding expert and resource for coding teams, ensuring accuracy and adherence to standards Develop and refine coding policies and procedures in collaboration with the HIM team Required Qualifications Associates or Bachelor's degree in Nursing or Health...Information Management (RHIA or RHIT) 5+ years of experience in claims auditing, quality assurance, or recovery auditing, preferably in a DRG/Clinical Validation Audit setting Coding certifications: RHIA or RHIT; CCS or CIC preferred 5-10 years ofTexas Licensed PM&R Physician
credentialing and state licenses, and return cases with clear rationales Identify and utilize current criteria and resources to support decision-making in reviews Required Qualifications Board certified MD or DO with an understanding of network services and managed...care Current, unrestricted clinical license(s) or a process to ensure compliance with restrictions Active medical practice required to perform appeals Post-graduate experience in direct patient care Board certification by relevant medical specialtiesNew Jersey Licensed PM&R Physician
with clear rationales in a timely manner Identify and utilize current criteria and resources to support objective decision-making in reviews Required Qualifications, Training, and Education Board certified MD or DO with a strong understanding of managed...care and quality assurance Current, unrestricted clinical license(s) or a process in place to ensure compliance with restrictions Board certification by relevant medical specialties is required Active medical practice is necessary to perform appealsRemote Compliance Internal Auditor
Required Qualifications Bachelor's degree in Business, Accounting, Finance, Healthcare, or related field 2+ years of experience in public accounting, internal audit, or related operational auditing Knowledge of Generally Accepted Accounting Principles Health...Care industry experience preferred CPA, CIA, and/or CISA certifications preferredFlorida Licensed Quality Improvement VP
including quality improvement and NCQA accreditation Experience in managing acquisition and integration of external data sources Previous management experience with responsibilities for hiring and training staff RN license and Certified Professional in Health...Care Quality preferredInpatient Coding Coordinator
conduct system training and prebill audit reviews Required Qualifications 3-5 years of acute hospital coding experience Skilled and working knowledge of MS Office suite Ability to analyze coding-related reports and take action Associate's degree in Health...Information Management RHIT or CCS certificationQuality Improvement Manager
and represents the organization at state Quality Management meetings Required Qualifications: Bachelor's Degree in nursing, Company administration, or a related field; Master's Degree preferred 5+ years of progressive experience in healthcare or managed...care In-depth knowledge of clinical quality management and related business practices Experience with Medicaid/Medicare recipients and community services preferred Lean Six Sigma or CPHQ training preferred
