Quality Analyst | Telecommute
3 days ago
Title: Quality AnalystPosition: ContractDescription: Senior Analyst(s) will be responsible for end-to-end business process activities - creating, controlling and improving the performance guarantee processes related to Prior Authorization and Appeals. Will lead process design and project implementation teams to assure program compliance and quality control for adherence to audit requirements based on governing bodies for the 19 states serviced by Community and State. Responsible for diagnosing process improvement opportunities and developing solutions using principles of process excellence and related tools. This position is also responsible for quality reporting, analysis, audits and for developing plans and programs to support continuous quality improvement using applicable tools. May assist in the creation, implementation, and evaluation of Total Quality Management (TQM) programs surrounding PA and Appeal related performance guarantees. May direct design, facilitation, training and evaluation of TQM incentive programs and may oversee quality improvement projects and teams in functional area. The Prior Authorization Governance and Auditing Group provides audit and regulatory support related to Prior Authorization and Appeals for all clients. The analyst(s) will serve as the regulatory subject matter expert during oversight and delegation audits performed by various clients. Analyst(s) will be responsible to analyze and report OOC data, perform clinical review on all DOI inquiries to ensure the PA and appeal process are aligned with regulatory guidance. Analyst(s) will lead data validation efforts for PA and Appeals including quality control for adherence to accreditation, state and federal program requirements. Clinical validation includes review of prior authorization cases for clinical decision-making based on individual plan formulary and requirement and patient demographics. The analyst(s) will ensure compliance to various regulations based on lines of business and plan design. In addition to audit support, the analyst(s) will be involved with trending to identify process improvements to ensure compliance with applicable state and federal laws, business contract requirements, prevent untimely cases and maintain client relations. Analyzes and investigates root cause of non-compliant cases. Required Skills : QualityAdditional Skills : Quality Engineer,AnalystThis is a high PRIORITY requisition. This is a PROACTIVE requisition
-
Data analyst | Telecommute
21 hours ago
, , United States Kaav Inc. Full time100% TELECOMMUTEHours: 8am - 5pm CST, can flex an hour or two either way depending on the time zone of the analyst. Interview Process: via video Responsibilities: Assesses and interprets customer needs and requirements. Identifies solutions to non-standard requests and problems. Solves moderately complex problems and/or conducts moderately complex...
-
Epic Analyst "Clinical/Nursing" Emphasis
1 week ago
, , United States Forrest General Hospital Full timeJob Summary: Attend class, complete required testing and projects to obtain and maintain EMR system certifications as required/assigned. The certification process will provide software programming and configuration skills necessary to complete job duties. With guidance, participates in activities associated with the work flow analysis, data collection,...
-
Epic Analyst "Clinical/Nursing" Emphasis
5 days ago
, , United States Forrest General Hospital Full timeJob Summary: Attend class, complete required testing and projects to obtain and maintain EMR system certifications as required/assigned. The certification process will provide software programming and configuration skills necessary to complete job duties. With guidance, participates in activities associated with the work flow analysis, data collection,...
-
Epic Analyst "Clinical/Nursing" Emphasis
2 weeks ago
, , United States Forrest General Hospital Full timeJob Summary: Attend class, complete required testing and projects to obtain and maintain EMR system certifications as required/assigned. The certification process will provide software programming and configuration skills necessary to complete job duties. With guidance, participates in activities associated with the work flow analysis, data collection,...
-
Epic Analyst "Clinical/Nursing" Emphasis
1 week ago
, , United States Forrest General Hospital Full timeJob Summary: Attend class, complete required testing and projects to obtain and maintain EMR system certifications as required/assigned. The certification process will provide software programming and configuration skills necessary to complete job duties. With guidance, participates in activities associated with the work flow analysis, data collection,...
-
Epic Analyst "Clinical/Nursing" Emphasis
12 hours ago
, , United States Forrest General Hospital Full timeJob Summary: Attend class, complete required testing and projects to obtain and maintain EMR system certifications as required/assigned. The certification process will provide software programming and configuration skills necessary to complete job duties. With guidance, participates in activities associated with the work flow analysis, data collection,...
-
Epic Analyst "Health Care Billing" Emphasis
2 weeks ago
, , United States Forrest General Hospital Full timeJob Summary: Attend class, complete required testing and projects to obtain and maintain EMR system certifications as required/assigned. The certification process will provide software programming and configuration skills necessary to complete job duties. With guidance, participates in activities associated with the work flow analysis, data collection,...
-
Senior Business Analyst
1 week ago
, , United States Cynet Systems Full timeJob Description: The client is seeking an Expert Level Business Analyst contractor for an approximately 12-month engagement for the Transportation systems. The Business Analyst will be responsible for the development of business requirements and for the development and delivery of business process and IT application training materials. This individual...
-
Business Analyst
2 weeks ago
, , United States Cynet Systems Full timeJob Description: The Client is seeking a Junior level Technical Specialist contractor for a 12-month engagement for the Department's Engineering Application Services as a SPECS Team Technical Specialist. This self-driven person will be responsible for delivering business and system requirements, understanding data flow requirements between our major...
-
Business Analyst
5 days ago
, , United States Cynet Systems Full timeJob Description: The Client is seeking a Junior level Technical Specialist contractor for a 12-month engagement for the Department's Engineering Application Services as a SPECS Team Technical Specialist. This self-driven person will be responsible for delivering business and system requirements, understanding data flow requirements between our major...
