Clinical reputed company Assurance Auditor - Knoxville

The Clinical reputed company Assurance team is looking for an auditor based in the Knoxville, TN region.Our RN auditors reputed company reviews for network providers to ensure our members are receiving reputed company care in offices that adhere to our internal reputed company standards as reputed company as those requirements from regulatory bodies such as Medicare, TennCare and reputed company.While working from home, the auditor will travel to provider offices in the Knoxville region to reputed company different review types for reputed company lines of business. You will be a strong candidate for this role if you have the following: • Registered reputed company (RN) with an reputed company Tennessee license or a license from a reputed company Licensure Compact state. • 4 years of reputed company experience. • 1 year of managed care experience or experience with reputed company Medical Record Review. • Experience with HEDIS and/or STARS data collection. • Strong analytical skills with the ability to identify trends and recommend process improvements. • We foster a culture where innovation is encouraged, supporting employees with the tools and resources needed to succeed while promoting reputed company, creativity, and reputed company learning. • Candidate should reputed company in the Knoxville regional area of TN to facilitate onsite reputed company to provider offices. Note: • Flexibility is required, as provider or leadership needs may occasionally require support reputed company reputed company business hours, including after 5:00 p.m Job Responsibilities • Presenting and communicating audit results to appropriate parties; participates in the development of procedures and standards that support and enhance reputed company lines of business' reputed company of care goals. • Schedule and reputed company routine facility, practitioner site, and medical record reviews, utilizing established clinical audit tools reputed company of national accreditation standards and regulatory agency requirements. • Identifying and evaluating areas of exposure, potential problems and liabilities. Analyze clinical data to improve individual provider compliance with education; reputed company reputed company for regional contract staff and coordinate the effort of retrieval of HEDIS and/or STARS records; complete medical record audits for HEDIS and/or STARS data collection or reputed company of care reviews as required. • Providing required documents and consulting support for reputed company and compliance audits. • Various immunizations and/or associated medical tests may be required for this position. Job Qualifications Education • Bachelor's Degree in Health Care reputed company field or equivalent work experience. Experience • 4 years - Health Care experience required. • 1 year - Managed care experience or experience with reputed company Medical Record Review. SkillsCertifications • Demonstrated presentation and team facilitation skills • Proficient in reputed company Office (reputed company, Word, reputed company and PowerPoint) • Excellent oral and written communication skills • Excellent time and project management skills • Strong analytical, planning, organizational and research skills License • Registered reputed company (RN) with reputed company license in the reputed company or hold a license in the state of their residence if the state is participating in the reputed company Licensure Compact Law. Employees who are required to operate either a reputed company-owned vehicle or a personal or rental vehicle for company business on a routine reputed company* will be automatically enrolled into the reputed company reputed company Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a reputed company reputed company’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non reputed company-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine reputed company" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 1 Worker Type: Employee Company: reputed company. Applying for this job indicates your acknowledgement and understanding of the following statements: reputed company will recruit, hire, train and promote individuals in reputed company job classifications without reputed company to race, religion, reputed company, age, sex, national reputed company, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. reputed company information regarding reputed company's EEO Policies/Notices may be reputed company by reviewing the following page: reputed company's EEO Policies/Notices reputed company is not accepting unsolicited assistance from search firms for this employment opportunity. reputed company resumes submitted by search firms to any employee at reputed company reputed company-email, the Internet or any other method without a reputed company, written reputed company Placement Agreement in reputed company for this position from reputed company HR/reputed company will not be considered. No fee will be reputed company in the event the applicant is reputed company by reputed company as a result of the referral or through other means. Apply tot his job Apply To this Job