LPN Auditor

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Manage and prioritize incoming referrals, oversee case assignments, and ensure cases are resolved effectively.

• Coordinate and conduct thorough quality reviews of medical records for PCPs, OBGYNs, and High Volume Specialists.

• Assist the QM RN in the investigation and analysis of quality-of-care issues.

• Abstract medical records, assess data, and input data to meet contractual obligations and organizational goals.

• Design tools and processes for clinical medical record audits.

• Perform data analysis utilizing Microsoft Excel and information from ManagedCare.com, TCS, medical records, and survey instruments.

• Retrieve and conduct medical record audits to evaluate provider compliance with AHCCCS documentation standards.

• Track and monitor Corrective Action Plans while communicating audit outcomes and best-practice recommendations to providers.

• Produce written documentation and Corrective Action Plans, coordinating with the Credentialing Department.

• Identify potential risk or compliance issues and support QM policies and procedures.

• Aggregate and analyze annual medical record audit results for OFR-required data.

• Generate monthly provider profile data reports for the Credentialing Department.

• Abstract and assist in the analysis of medical record data following HEDIS specifications.

• Collaborate with the HEDIS team on performance metrics, methodologies, and processes.

• Create datasets and databases for quality, medical management, and departmental research.

• Promote continuous improvement and complete assigned tasks in the AHCCCS review work-plan.

⛳️ Requirements

• Must possess a current, unrestricted LPN license from the State of Arizona.

• A minimum of two years of experience, ideally in a family practice or pediatric medical office environment.

• Willingness to travel to all contracted sites, which may require occasional overnight stays.

• Capable of working independently as well as collaboratively within an interdisciplinary team.

• Excellent verbal and written communication capabilities.

• Strong teamwork and collaboration skills.

• High level of attention to detail and accuracy.

• Knowledge and comprehension of HEDIS specifications.

• Strong leadership, problem-solving, and investigative abilities.

• Ability to maintain strict confidentiality.

• Capacity to prioritize tasks in a fast-paced environment.

• Competence in implementing standards, data sources, research tools, and data collection instruments.

• Skills in collecting, analyzing, describing, and evaluating data and writing reports.

• Ability to implement and monitor the effectiveness of process improvements.

• Capability to identify risk-management issues.

• Proficiency in reviewing and extracting relevant data from medical records.

• Familiarity with NCQA, HEDIS, AHCCCS, and CMS standards and reporting requirements.

🏝️ Benefits

• Comprehensive one-on-one training provided by seasoned investigators.

• Opportunity for remote work.

• Note: Banner Staffing Services roles do not include medical benefits or paid time off accrual.

• Assignment-based position with no guarantee of hours.