Auto Insurance • Workers' Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance
1001 - 5000 employees
Founded 1913
January 24
🦌 Connecticut – Remote
🏖️ New Jersey – Remote
+2 more states
💵 $77.9k - $104.4k / year
⏰ Full Time
🟡 Mid-level
🟠 Senior
🔎 Auditor
Auto Insurance • Workers' Compensation Insurance • Homeowners Insurance • Commercial Auto Insurance • Renters Insurance
1001 - 5000 employees
Founded 1913
• Responsible for conducting file audits for all areas of clinical operations • Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS • Analyze, prepare, and distribute quarterly audit outcomes including error trends, to the Business Unit Directors • Conduct monthly CMS-CAPs audits against business Process Flows in order to evaluate compliance with Medicare standards • Primary responsibility for documentation of CMS-CAPs results in SharePoint database and generation of communication/notification to Directors regarding the outcome including the analysis of error trends • Outcomes are then used for process improvement recommendations and changes as well as education/training • Serves as database administrator and facilitates biannual MCG-IRR testing (Milliman Care Guidelines-Inter Rator Reliability) that is administered to clinical and medical director staff • This includes general maintenance and troubleshooting during entire testing period • Notification of testing dates to staff, analysis of final reports and submission of reports to functional unit Directors and Medical Management Committee for follow up education of staff by Management • Conduct ad hoc file audits against business process flows when new business practices are set in place to monitor adherence to Process Flow as it relates to regulatory compliance • Completes other assigned functions, including special projects, as requested by management
• Bachelor's degree preferred • Requires a minimum of three (3) years clinical experience • Strongly prefers a minimum of three (3) years clinical quality or audit experience • Active Unrestricted NJ RN, LCSW, LMFT, LSW or LPC License Required • 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 • Knowledge of HEDIS measures and specifications strongly preferred • Requires excellent verbal and written communication skills • Analytical & Problem Solving • Continuous Improvement • Information & Knowledge Sharing • Process Management • Interpersonal & Client Relationship • Presentation • Prefers knowledge of audit methodologies and procedures
• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement
Apply NowJanuary 23
Join CATHEXIS as a Healthcare Auditor to perform audits on VA's financial practices.
January 22
As a Hospital Coding Auditor, you'll review charges for accurate coding and documentation in the healthcare sector.
🇺🇸 United States – Remote
💵 $43.9k - $70.6k / year
🔥 Funding within the last year
💰 Private Equity Round on 2024-07
⏰ Full Time
🟡 Mid-level
🟠 Senior
🔎 Auditor
🦅 H1B Visa Sponsor
January 17
Circle K is hiring an Inventory Auditor to support operations in New Orleans Area.
January 15
Join ReSource Pro as an Insurance Physical Auditor to conduct audits for insurance carriers in California.
January 15
Join ReSource Pro as an Insurance Physical Auditor, conducting audits and building client relationships.
Discover 70,000+ Remote Jobs!
Join now to unlock all job opportunities.
We use powerful scraping tech to scan the internet for thousands of remote jobs daily. It operates 24/7 and costs us to operate, so we charge for access to keep the site running.
Of course! You can cancel your subscription at any time with no hidden fees or penalties. Once canceled, you’ll still have access until the end of your current billing period.
Other job boards only have jobs from companies pay to post. This means that you miss out on jobs from companies that don't want to pay. On the other hand, Remote Rocketship scrapes the internets for jobs and doesn't accept payments from companies. This means we have thousands of more jobs!
New jobs are constantly being posted. We check each company website every day to ensure we have the most up-to-date job listings.
Yes! We’re always looking to expand our listings and appreciate any suggestions from our community. Just send an email to Lior@remoterocketship.com. I read every request.
Remote Rocketship is a solo project by me, Lior Neu-ner. I built this website for my wife when she was looking for a job! She was having a hard time finding remote jobs, so I decided to build her a tool that would search the internet for her.