Provider Services Auditor

Department :

10702 Advocate Aurora Health Corporate - Managed Care : Operations

Status : Full time

Benefits Eligible : Yes

Hou rs Per Week : 40

Schedule Details / Additional Information :

Will work Monday-Friday with hours between 7-4 : 30 CST. This is a remote role. Advocate may approve remote workers who reside in the following registered states : AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.

Pay Range

$28.05 - $42.10

Manages and oversees the comprehensive quality assurance and training programs.

Essential Functions

• Creates and maintains quality sampling, review, and reporting policies and procedures that are effective and objectively compliant. Provides necessary definition, development and deployment of quality assurance strategy to address all phases of quality management.
• Collaborates with senior specialists on teammates quality reviews, training, preparation and content of staff performance evaluations and development of action plans related to identified staff performance deficiencies.
• Solicits input and works interactively with stakeholders in other areas to ensure effective cross-functional cooperation on shared quality and training objectives.
• Creates and maintains effective training materials, policies, and procedures. Provides necessary definition, development, and deployment of training plans and strategy addressing all phases of training.
• Confers with management and conducts surveys to identify educational needs based on projected growth, changes in processes, and payer requirements.
• Develops and deploys e-learning and self-paced training capabilities.
• Supports leadership as quality and education subject matter expert for audits of credentialing files requested by delegated managed care organizations and outside regulatory agencies.
• Maintains records of audit results, action plans, and managed care contacts.
• Establishes and maintains a policy for documentation of all quality and education processes and guidelines and ensures departmental documentation is maintained in compliance with external regulatory standards.
• Serves as a subject matter resource for managed care credentialing, government enrollment, and provider data management to MHR and to the Provider Services teams.
• Serves as a Team lead for the units when the regular Team Leads are out of the office.

Physical Requirements

Performs most work under normal office conditions. May include sitting for long periods of time, standing, walking, using repetitive wrist and arm motion or lifting articles up to twenty five pounds.

Education, Experience and Certifications

Bachelor's degree in a related field is required. BA / BS in business or other analytical area preferred. 1-3 years prior experience in an operational quality management role in a managed care plan, insurer, or a related processing or compliance setting required. Prior managed care credentialing experience and working knowledge of managed care payer, Medicare, Medicaid, NCQA and data standards preferred. Prior experience leading and managing a team is preferred. Strong Proficiency with Microsoft Excel and other applications, data integrity principles, and developing and creating reports in varied formats is required. Understanding of managed care credentialing and government enrollment processes, policies and guidelines is required. Strong listening, written / verbal communication, and presentation skills, and superior interpersonal and teaming skills are required. Experience in conducting statistically valid quality reviews, analyses, and audits, developing and executing performance improvement action plans and attaining organizational goals is required. Experience in word processing, and business correspondence is required. High degree of organizational skills and problem solving skills is required.

Our Commitment to You :

Advocate Health offers a comprehensive suite of Total Rewards : benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including :

Compensation

Benefits and more

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.