Clinical Coding Auditor

4 days ago

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10,000+

💰 $20M Series F on 2005-12

Description

• perform audit functions for Healthfirst clinical teams to determine operational efficiency • maintain tracking tools to log audit results • assist with evaluating and analyzing aggregate quality performance data • develop strategies for business performance improvement initiatives • apply clinical and critical thinking skills to evaluate the quality and effectiveness of case management

Requirements

• NYS LPN or RN license • unexpired NYS driver's license or NYS ID required • relevant previous work experience such as medical records review; claims processing; utilization/case management in a clinical practice or managed care organization; • knowledge of Department of Health (DOH) and Local Department of Social Services and Center for Medicare & Medicaid Services (CMS) regulations • nursing experience in an acute, sub-acute or long-term care (LTC) setting or managed long-term care plan (MLTCP, FIDA); • familiarity with CareEnhance Clinical Management Software (CCMS), TrueCare, PEGA, Citrix, RightFax, VoIP, Virtual work platforms (VPN), Electronic medical record (EMR) database containing patient health information (PHI), and/or MACESS archival system • language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese • intermediate Microsoft Word, Excel, and Outlook skills • ability to build and maintain positive relationships with cross-functional teams and interact with all levels of management • time management, critical/creative thinking, project management, communication, and problem-solving skills

Benefits

• medical, dental and vision coverage • incentive and recognition programs • life insurance • 401k contributions