Audit Coordinator | 3+ years’ experience |Hybrid | Contract
Walker Healthforce is seeking a Audit Coordinator with 5 years’ experience to support a healthcare client. This is a 12-month contract to hire opportunity.
START DATE: ASAP
HOURS/SCHEDULE: Monday-Friday, 40 hours
WORKER TYPE: W2
CORE REQUIREMENTS:
- Associate Degree in Business or Medical OR 3 or more years experience in a managed care environment.
- 2 years in a leadership role that includes direct accountability and responsibility and direction of staff.
- 2 years’ experience in directly performing delegated oversight activities.
- Project Management skills and experience.
- Knowledge of regulatory/accreditation requirements and standards (TDI, NCQA, URAC).
- Verbal and written communication skills.
- Organizational skills and the ability to handle multiple priorities.
- PC proficiency to include Word, Excel, PowerPoint and Lotus Notes.
- Ability to travel (up to 30-40%) within Texas. Minimal travel outside of the state..
ADDITIONAL REQUIREMENTS:
- Must reside in Chicago, IL
WE CONSIDER IT A BONUS IF YOU ALSO HAVE:
- Bachelor Degree in Business or Medical.
- Knowledge of Power Point, Visio and Access.
- College level courses or certification in project management.
JOB RESPONSIBILITIES:
- Develop, implement and manage processes and systems to monitor and evaluate all statewide delegated activities to groups, IPAs and vendors for PPO, POS and HMO products.
- Establish and maintain pre-delegated and delegated oversight documentation (policies, procedures, audit tools, reporting formats, communication materials and scheduling) that is consistent with the intent of regulatory/accreditation requirements.
- Maintain relationships with contacts at delegated groups to assure complete, timely and accurate communication regarding delegated functions and responsibilities.
- Coordinate with key internal areas (Legal, HMO Compliance, Network Management, UM/QI, Finance) to ensure accurate and timely communication regarding the status of delegated groups, appropriate delegated contractual terms and pertinent information is distributed regarding new/revised regulations.
- Keep abreast of current regulatory/accreditation requirements (Texas Department of Insurance, NCQA, URAC, NAC).
- Review and evaluate mandatory delegated oversight reporting and follow processes to ensure timelines are met and information is disseminated throughout the organization for analysis, identification of opportunities to improve and incorporation of action plans, ongoing monitoring or de-delegation procedures as appropriate.
- Participate in the management of member and provider complaints and appeals to assure appropriate resolution within established timeframes.
Schedule, organize and perform annual and other periodic onsite audits at delegated entity locations.
- Provide formalized delegated oversight reporting as scheduled to appropriate committees and departments to facilitate communication of delegated oversight results and coordinate corrective action plans.
- Maintain manuals documenting oversight agreements, delineation of responsibilities, reporting, audit results and key communications for each delegate.
- Represent the department and division in meetings, committees and internal and external presentations.
WHAT WE OFFER:
- Competitive compensation package
- Weekly pay via Direct Deposit
- Medical, Dental & Vision available
- 401k options
WHY WORK WITH WALKER?
- Access to our top ranked team of recruiting and placement specialists
- Continuous, one-on-one support from a dedicated engagement manager
- Professional resume development and interview preparation
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US:
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
#IND1 