Field LPN Auditor, Clinical Quality Management - Phoenix, AZ
About the position
This position at UnitedHealthcare involves gathering and auditing medical records from healthcare providers, analyzing and reporting results, and developing quality improvement plans. The role is crucial in ensuring compliance with Medicaid regulations and improving healthcare quality. It offers a hybrid-remote work model for residents of Phoenix, AZ, with a significant focus on provider education and collaboration.
Responsibilities
Ā Review and audit Medicaid (AHCCCS) Electronic Visit Verification (EVV) providers and medical records regarding AHCCCS AMPM requirements around EVV
,
Ā Review, audit and evaluate documentation of medical records
,
Ā Review/interpret medical records/data to determine whether there is documentation reflected accurately in medical record
,
Ā Follow relevant regulatory guidelines, policies and procedures in reviewing clinical documentation
,
Ā Prioritize providers for medical chart review according to collaboration with other Health Plans
,
Ā Identify incomplete/inconsistent information in medical records and label missing measures/metrics/concerns
,
Ā Review relevant tool specifications to guide chart review
,
Ā Review/interpret/summarize medical records/data to address any quality of care questions
,
Ā Verify necessary documentation is included in medical records
,
Ā Maintain HIPAA requirements for sharing minimum necessary information
,
Ā Identify potential quality of care issues and potential fraud/waste/abuse based on clinical data/documentation
,
Ā Refer issues identified to relevant parties for further review/action
,
Ā Discuss with provider offices to address and request corrective action plans
,
Ā Educate provider representatives/office staff to address/improve auditing processes
,
Ā Educate providers on proper medical record documentation for regulatory compliance
,
Ā Educate providers offices on specifications/measures
,
Ā Explain/convey technical specifications regarding action plans/follow up
,
Ā Explain how provider scores are calculated/determined
,
Ā Demonstrate knowledge of public healthcare insurance industry products
,
Ā Prepare for and participate in meetings with State agencies, providers, and stakeholders as well as internal meetings
,
Ā Assist with other quality management audits, corrective action plans as needed
Requirements
Ā High School Diploma/GED (or higher)
,
Ā Active and unrestricted LPN license in the state of Arizona
,
Ā 3+ years of experience in the Medicaid health field including provider interactions
,
Ā 2+ years of experience reviewing medical record charts/documentation and writing regulatory reports
,
Ā Intermediate level of proficiency with software applications including Microsoft Word, Excel and Teams
,
Ā Reliable transportation for field visits
,
Ā Ability to travel 50% for the position throughout Arizona when business requires
Nice-to-haves
Benefits
Ā Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
,
Ā Medical Plan options along with participation in a Health Spending Account or a Health Saving account
,
Ā Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage
,
Ā 401(k) Savings Plan, Employee Stock Purchase Plan
,
Ā Education Reimbursement
,
Ā Employee Discounts
,
Ā Employee Assistance Program
,
Ā Employee Referral Bonus Program
,
Ā Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
Apply Now
This position at UnitedHealthcare involves gathering and auditing medical records from healthcare providers, analyzing and reporting results, and developing quality improvement plans. The role is crucial in ensuring compliance with Medicaid regulations and improving healthcare quality. It offers a hybrid-remote work model for residents of Phoenix, AZ, with a significant focus on provider education and collaboration.
Responsibilities
Ā Review and audit Medicaid (AHCCCS) Electronic Visit Verification (EVV) providers and medical records regarding AHCCCS AMPM requirements around EVV
,
Ā Review, audit and evaluate documentation of medical records
,
Ā Review/interpret medical records/data to determine whether there is documentation reflected accurately in medical record
,
Ā Follow relevant regulatory guidelines, policies and procedures in reviewing clinical documentation
,
Ā Prioritize providers for medical chart review according to collaboration with other Health Plans
,
Ā Identify incomplete/inconsistent information in medical records and label missing measures/metrics/concerns
,
Ā Review relevant tool specifications to guide chart review
,
Ā Review/interpret/summarize medical records/data to address any quality of care questions
,
Ā Verify necessary documentation is included in medical records
,
Ā Maintain HIPAA requirements for sharing minimum necessary information
,
Ā Identify potential quality of care issues and potential fraud/waste/abuse based on clinical data/documentation
,
Ā Refer issues identified to relevant parties for further review/action
,
Ā Discuss with provider offices to address and request corrective action plans
,
Ā Educate provider representatives/office staff to address/improve auditing processes
,
Ā Educate providers on proper medical record documentation for regulatory compliance
,
Ā Educate providers offices on specifications/measures
,
Ā Explain/convey technical specifications regarding action plans/follow up
,
Ā Explain how provider scores are calculated/determined
,
Ā Demonstrate knowledge of public healthcare insurance industry products
,
Ā Prepare for and participate in meetings with State agencies, providers, and stakeholders as well as internal meetings
,
Ā Assist with other quality management audits, corrective action plans as needed
Requirements
Ā High School Diploma/GED (or higher)
,
Ā Active and unrestricted LPN license in the state of Arizona
,
Ā 3+ years of experience in the Medicaid health field including provider interactions
,
Ā 2+ years of experience reviewing medical record charts/documentation and writing regulatory reports
,
Ā Intermediate level of proficiency with software applications including Microsoft Word, Excel and Teams
,
Ā Reliable transportation for field visits
,
Ā Ability to travel 50% for the position throughout Arizona when business requires
Nice-to-haves
Benefits
Ā Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
,
Ā Medical Plan options along with participation in a Health Spending Account or a Health Saving account
,
Ā Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage
,
Ā 401(k) Savings Plan, Employee Stock Purchase Plan
,
Ā Education Reimbursement
,
Ā Employee Discounts
,
Ā Employee Assistance Program
,
Ā Employee Referral Bonus Program
,
Ā Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
Apply Now