Quality Auditor in Pennington, NJ

Job Summary:

• This position is responsible for conducting quality audits for state audits, HEDIS and quality referral and complaints issues.

Responsibilities:

1. Conducts on-site/virtual reviews at participating provider offices to assess environment, quality of physicians medical records, and compliance with HEDIS documentation standards.
2. Attends HEDIS Measure and QMRM (documenting platform) training and passes with 100% accuracy.
3. Assists the Quality Management department with various special projects and focused clinical studies.
4. Performs related tasks or special studies as requested.
5. Assists in training of, providers on audit standards, off site.
6. In-house representative for chart chase audits.
7. Produces various reports as requested.
8. Reviews supplemental data charts (approx. 50 charts per day) as assigned by team leads. Charts are audited and processed in the format provided through Excel.
9. Works with providers to obtain charts for chart chase. Charts are processed and reviewed in a timely manner (24 hours).

Qualifications:

Education/Experience:

1. Requires three to five years related business experience, preferably n health care industry.
2. Requires License Practical Nurse License or an active New Jersey Registered Nurse License.

Additional licensing, certifications, registrations:

1. Requires valid Motor Vehicle driver's license and access to an automobile.

Knowledge:

1. Requires knowledge of managed care principles.
2. Requires knowledge of medical terminology.
3. Requires knowledge of PC's and related software.
4. Prefers knowledge of URAC accreditation standards and HEDIS principles.
5. Prefers knowledge of health management or patient education.

Skills and Abilities:

1. Require excellent verbal and written communication skills.
2. Requires excellent organization skills.
3. Require strong analytical skills.
4. Requires good problem solving/conflict resolution skills.
5. Requires good decision making skills.
6. Requires strong PC skills.
7. Require strong presentation skills.

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