Department Name:
Work Shift:
Day
Job Category:
Risk, Quality and Safety
As an HP LPN Auditor , you will independently triage incoming referrals, manage case assignments, and oversee cases through resolution while ensuring compliance with AHCCCS, Medicare, and Medicaid requirements. This role partners closely with internal teams and external stakeholders to support accurate case management, and regulatory compliance. The ideal candidate is detail-oriented, able to work autonomously, and committed to delivering high-quality outcomes. Comprehensive one-on-one training is provided by experienced investigators to support success in the role.
Your work shifts will be Monday-Friday 8:00am- 4:30pm. This is a remote opportunity. CANDIDATES MUST RESIDE IN THE STATE OF ARIZONA TO BE CONSIDERED.
Please note Banner Staffing Services roles do not offer medical benefits or paid time off accrual. These roles are assignment based with no guarantee of hours and assignments can conclude at any time. MUST RESIDE IN THE STATE OF AZ. If this role sounds like the one for you, Apply Today!
POSITION SUMMARY
This position coordinates and performs quality medical record reviews of the ambulatory medical record for PCP’s, OBGYN and High Volume Specialists (HVS). This position is also responsible for assisting the QM RN with the investigation and research of quality of care concerns that have been referred to the Quality Management Department for review and resolution. In addition, the position is also responsible for abstracting medical records, analyzing data and importing data to ensure that all contract requirements and UAHN/MHP initiatives are completed successfully and timely.
CORE FUNCTIONS
1. Assists in the development of clinical medical record audit tools and processes. Conducts data analysis using Microsoft Excel; Requests, compiles, sorts, prepares, reviews, validates, and analyzes data extracted from ManagedCare.com, TCS, medical records and survey tools using statistically reliable sampling methods.
2. Coordinates, retrieves, and performs medical record audits to determine provider compliance with established AHCCCS standards for documentation in conjunction with the re-credentialing process.
3. Monitors and tracks Corrective Active Plans (CAPs), in collaboration with the Manager, Supervisor or QM RN and communicates audit results to providers along with education about best practices and recommendations for improvement as outlined in established guidelines.
4. Provides written documentation and Corrective Action Plans as directed by the Credentials Committee to providers when necessary, and coordinates communication with the Credentialing Department.
5. Reports potential risk or compliance issues identified in the audit process to the Manager/Supervisor of QM. Assists in the development of QM policies and desktop procedures. Provides input and feedback on opportunities for improvement; Aggregates and analyzes medical record audit results on an annual basis for OFR required data. Participates in system-focused analyses in response to error identification.
6. Coordinates, collects data and prepares monthly provider profile data reports for the Credentialing Department. Coordinates, abstracts, and assists with the analysis of data from medical records in accordance with HEDIS specifications. Actively works with the HEDIS team to ensure understanding of performance measures, methodology and processes.
7. In collaboration with Director, Manager, Supervisor of Quality Management and Information Systems, creates datasets for review by the Quality and Medical Management Administration Staff and other department studies as assigned, including but not limited to setting up database and associated data entry programs, and retrieving data from the database for purposes of analysis or data review.
8. Supports the continuous improvement of the department, Medical Management, and UAHP through active participation in strategies to enhance organizational structure and processes. Responsible for working toward achieving full compliance in assigned areas for the annual AHCCCS operation review and complete all assigned work plan tasks.
9. This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization.
MINIMUM QUALIFICATIONS
Current, unrestricted State of Arizona LPN license. Two years of experience, preferably in a family practice or pediatric medical office setting, with the ability to travel to all contracted sites, which may necessitate occasional overnight stays.
The ability to function both as a member of an interdisciplinary team as well as the ability to function independently. Excellent verbal and written communication skills and the ability to develop a strong rapport with providers and staff in a variety of clinical settings; Strong collaborative skills (ability to work with a team or individually). An aptitude for accuracy with attention to detail. Knowledge and understanding of HEDIS specifications; Strong leadership skills (can construct a vision, thinks creatively to solve issues and is goal oriented); the ability to maintain strict confidentiality along with good problem solving and investigative skills is required.
Ability to set appropriate priorities relative to work load in a fast paced environment; to implement standards and data sources, research tools, and other data collection instruments; to collect, analyze, describe, evaluate data, and write reports; to implement and track the effectiveness of process improvement; to recognize risk management concerns; and to review and extract significant data from medical records is required. Must be knowledgeable of the National Committee for Quality Assurance (NCQA), Health Plan Employer Data Information Set (HEDIS), Arizona Health Cost Containment System (AHCCCS) and Centers for Medicare and Medicaid Services (CMS) standards and reporting requirements.
PREFERRED QUALIFICATIONS
Additional related education and/or experience preferred.
Estimated Pay Range:
$28.28 - $47.13 / hour
Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.
This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.
EEO Statement:
EEO/Disabled/Veterans
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy