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Medical Auditor Specialist
2 months ago
Med National Staffing Inc. is seeking a highly skilled Medical Auditor Specialist to join our team. As a key member of our Delegation Oversight Department, you will be responsible for ensuring continuous quality improvements and compliance with regulatory requirements.
Key Responsibilities:
- Oversee delegated activities to ensure compliance with NCQA, CMS, and State Medicaid requirements.
- Coordinate, conduct, and document pre-delegation and annual assessments to comply with regulatory standards.
- Distribute audit results, follow-up letters, and annual reporting requirements as needed.
- Work with the Delegation Oversight Analyst to monitor performance reports from delegated entities.
- Develop corrective action plans and document follow-up to completion.
- Assist with meetings of the Delegation Oversight Committee.
- Collaborate with the Delegation Oversight Manager to develop and maintain delegation assessment tools, policies, and reporting templates.
- Assist with preparation of delegation summary reports submitted to the EQIC and/or UM Committees.
- Participate in Joint Operation Committees (JOC's) for delegated groups.
- Assist in preparation of documents for CMS, State Medicaid, NCQA, and/or other regulatory audits as needed.
Requirements:
- Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program.
- Minimum two years of Utilization Review experience.
- Knowledge of audit processes and applicable state and federal regulations.
- Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing.
Preferred Qualifications:
- Three-year NCQA, CMS, and/or state Medicaid UM auditing experience.
- Three years' experience in delegation oversight process and working knowledge of state and federal regulations.
- Active and unrestricted Certified Clinical Coder, Certified Medical Audit Specialists (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), or Certified Professional in Health Care Quality (CPHQ) certification.
About Med National Staffing Inc.
Med National Staffing Inc. is a full-service Healthcare Human Capital Solutions Organization. We deliver traditional permanent placement and contract service opportunities in various niche areas, including hospitals, physicians' offices, nursing care facilities, home healthcare services, government agencies, educational services, support services, schools, community centers, urgent care centers, and offices. Our mission is to deliver career-oriented and quality-focused healthcare professionals while enriching the lives of these professionals during their period of transition to a new challenge and opportunity.
