Medical Auditor in Chicago, IL at Volt

Date Posted: 8/23/2021

Job Snapshot

Job Description

Are you a licensed RN?  Looking for a position that utilizes your knowledge that is non-patient facing?  We have an opportunity for you!

Volt has an exciting opportunity with one of the Largest Commercial Health Insurer's located in Chicago, IL!!!

Job Description:

This position is responsible for ensuring the care coordination clinical records reflect accurate and timely documentation to meet compliance mandates.
This position will be responsible for the auditing of medical records for HEDIS, QRS and other quality measures; identify areas of opportunity to improve documentation and audit outcomes. This position impacts the integrity of the Medical Record validation process and HealthCare Effective Data & Information Set (HEDIS) Reporting. In addition, this position significantly contributes toward the achievement to maintain accreditation with national accreditation agencies.

This position is responsible for enterprise quality auditing support and functioning as subject matter expert in auditing processes and procedures; may provide support to users and have an active role in working on cross-functional teams to address the auditing issues; supporting datasets and reports for analysis using system reporting tools; performing research and assisting in analyzing data; supportive role related to interfacing between the business and divisional data teams to tools to be leveraged in reporting deliverables; working closely with customers to build relationships; and continuously gaining a deeper understanding in order to meet business needs; supportive role in analyzing complex business problems and issues; active role in supporting the identifying and interpreting trends and patterns in datasets to locate influences.

Registered Nurse (RN) with current, active, unrestricted RN license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.
3 years of clinical nursing experience.
2 years of managed care insurance medical review experience.

Knowledge of HEDIS and HEDIS type of reporting and or software tools
Knowledge of federal and state quality reporting and accreditation, regulations for the health insurance industry (URAC, NCQA, ACA, State Depts of Insurance and/or comparable regulatory bodies