Clinical Compliance Admin

Insight Global; Mandaluyong; On-site; PHP 420,000 - 640,000; Full time

Job summary

Insight Global is seeking a Clinical Quality & Operational Risk Management Auditor to support the clinical quality manager in daily tasks across the lifecycle of candidates onboarding and credentialing. You will perform weekly file audits, coordinate with the CQRM clinical manager, and help manage workload and deadlines.

The role involves backlog audits, real-time reporting of findings for high-risk situations, data cleanup, expiration tracking, and vendor coordination for credential

Responsibilities

• Perform weekly file audits of consultants cleared the week prior.
• Meet weekly with CQRM clinical manager to review audit status, updates to processes, and discuss any concerns noted during audits or other assigned tasks
• Communicate efficiently with CQRM clinical manager to determine workload for the week
• Prioritize and organize workload according to deadlines
• Perform one-off back log audits that may arise due to compliance findings
• Report on findings of audits in real time if strong risk is identified that clinical manager may need to intervene on
• Strive to maintain a discrepancy rate of 5% or less during second level review audit performed by clinical manager
• Assist with data clean up
• Additional audit duties as assigned
• Assistance with expiration tracking on a weekly basis, this includes sorting through reports and data, sending out communication notices to consultants with expiring item information and tracking follow ups until completed
• Ordering health screens for expiring credentials through a vendor system and following up in system until completed
• Performing primary source verifications of licensures and certifications to ensure quality standards are met
• Project management support with things such as flu season reporting and management
• Vendor support and escalation resolution

Job description

The Clinical Quality & Operational Risk Management Auditor is responsible for assisting the clinical quality manager with day-to-day tasks to ensure quality throughout the life cycle of candidates who are onboarded and credentialed through our team.

The responsibilities may include but are not limited to the following:

• Perform weekly file audits of consultants cleared the week prior, with volume ranging on a weekly basis
• Meet with CQRM clinical manager weekly to review audit status, updates to processes, and discuss any concerns noted during audits or other assigned tasks
• Communicate efficiently with CQRM clinical manager to determine workload for the week
• Prioritize and organize workload according to deadlines
• Perform one-off back log audits that may arise due to compliance findings
• Report on findings of audits in real time if strong risk is identified that clinical manager may need to intervene on
• Strive to maintain a discrepancy rate of 5% or less during second level review audit performed by clinical manager
• Assist with data clean up
• Additional audit duties as assigned
• Assistance with expiration tracking on a weekly basis, this includes sorting through reports and data, sending out communication notices to consultants with expiring item information and tracking follow ups until completed
• Ordering health screens for expiring credentials through a vendor system and following up in system until completed
• Performing primary source verifications of licensures and certifications to ensure quality standards are met
• Project management support with things such as flu season reporting and management
• Vendor support and escalation resolution