NJM Insurance Group
Auto Insurance • Workers' Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance
1001 - 5000
HEDIS Quality Auditor II - RN
October 4
NJM Insurance Group
Auto Insurance • Workers' Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance
1001 - 5000
Description
• Responsible for conducting file audits for all areas of clinical operations. • Conduct quarterly file audits for all lines of business against business Process Flows. • Analyze, prepare, and distribute quarterly audit outcomes including error trends. • Conduct monthly CMS-CAPs audits against business Process Flows to evaluate compliance. • Primary responsibility for documentation of CMS-CAPs results in SharePoint database. • Serves as database administrator and facilitates biannual MCG-IRR testing. • Conduct ad hoc file audits against business process flows when new business practices are set in place. • Completes other assigned functions, including special projects, as requested by management.
Requirements
• Prefers a Bachelor's degree. • Requires a minimum of three (3) years clinical experience. • Strongly prefers a minimum of three (3) years clinical quality or audit experience. • HEDIS experience strongly preferred. • Active Unrestricted NJ RN, LCSW, LMFT, LSW or LPC License Required. • RN license strongly preferred. • Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Microsoft Outlook. • Should be knowledgeable in the use of intranet and internet applications. • Requires knowledge of the following applications, which include but not limited to: Care Planner Web, UCSW, Appeal Pro, Care Radius, SharePoint, Membership, Benefits, Business Objects and CMS web sites. • Prefers knowledge of audit methodologies and procedures. • Requires excellent verbal and written communication skills. • Analytical & Problem Solving • Continuous Improvement • Information & Knowledge Sharing • Process Management • Interpersonal & Client Relationship • Presentation
Benefits
• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement
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