Healthcare Quality Analyst & Auditor

Prevea Health; Green Bay (WI); On-site; USD 60,000 - 75,000; Full time

Job summary

Prevea Health in Green Bay, Wisconsin is seeking a Quality Analyst/Auditor to manage quality-related aspects of insurance contracts, ensuring negotiated reimbursements for meeting quality metrics. The role involves reviewing medical records, analyzing payer data, and collaborating with providers and leadership to ensure accurate documentation and contract compliance.

You will develop educational materials, support contract reviews, prepare audit reports, and pursue opportunities to automate data

Qualifications

• Associate's Degree in Healthcare Administration or related field preferred.
• 2+ years healthcare-related work experience required.
• Experience with electronic medical records, EPIC, and Microsoft Office preferred.

Responsibilities

• Review medical records and extract relevant data to meet quality and audit metrics; verify accuracy of documentation and coding.
• Assist with implementation of new contracts and programs, ensuring workflows and processes meet contract requirements related to quality metrics.
• Develop educational materials and provide guidance to providers and staff related to quality metrics, documentation standards, and contract requirements.
• Support contract review by analyzing quality-related terms within assigned insurance contracts and amendments; interpret and communicate quality measure requirements and performance thresholds to support achievement of contract goals
• Prepare audit reports and streamline workflows to meet monthly, quarterly, and annual quality and performance goals.
• Monitor assigned contract performance to identify gaps in meeting quality requirements; recommend and support corrective actions as needed.
• Identify and support opportunities for automation of quality data extraction using EPIC or other data sources.
• Collaborate with Clinical Optimization Team, Chief Quality Officer, Chief Financial Officer, and Physicians/Clinicians to develop and implement best practices for quality-related workflows.

Skills

Analytical skills

Auditing

Medical records review

Data analysis

Communication skills

Education

Health Admin degree

Tools

EPIC

Microsoft Office

Job description

Prevea Health in Green Bay, Wisconsin is seeking a Quality Analyst/Auditor to manage quality-related aspects of insurance contracts, ensuring negotiated reimbursements for meeting quality metrics. The role involves reviewing medical records, analyzing payer data, and collaborating with providers and leadership to ensure accurate documentation and contract compliance.

You will develop educational materials, support contract reviews, prepare audit reports, and pursue opportunities to automate data