Role OverviewThe Quality Analyst/Auditor manages quality-related aspects of insurance contracts to ensure Prevea Health receives negotiated reimbursements for meeting required quality metrics. This position reviews medical records, analyzes payer data, and collaborates with providers and leadership to ensure accurate documentation, compliance, and optimization of quality performance tied to insurance contracts.
What You Will Do
Review medical records and extract relevant data to meet quality and audit metrics; verify accuracy of documentation and coding. Review reports and data provided by insurance payors; perform audits and medical record validation to ensure accuracy.
Why It Might Be a Fit
Support contract review by analyzing quality-related terms within assigned insurance contracts and amendments; interpret and communicate quality measure requirements and performance thresholds to support achievement of contract goals.
Requirements
- Associate's Degree Healthcare Administration or Technical Diploma in Healthcare related field
- 2+ years Healthcare related work experience
- Clinical experience as MA or LPN
- Experience with electronic medical records, EPIC, and Microsoft Office
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