HP LPN Auditor

Banner Health; United States; Remote; USD 55,000 - 75,000; Full time

Job summary

Banner Health is seeking an LPN Auditor to independently triage referrals, manage case assignments, and oversee case resolution while ensuring AHCCCS, Medicare, and Medicaid compliance. The role offers a remote work option with the requirement to reside in Arizona and occasional travel to contracted sites.

Comprehensive one-on-one training is provided by experienced investigators to support success. Responsibilities include conducting medical record audits, data analysis, and supporting the QM

Qualifications

• Current, unrestricted State of Arizona LPN license.
• Two years of experience in family practice or pediatric setting.
• Ability to travel to all contracted sites.

Responsibilities

• Triage incoming referrals and assign cases.
• Oversee cases through resolution while ensuring compliance with AHCCCS, Medicare, and Medicaid requirements.
• Coordinate data collection and abstract medical records for QA purposes.
• Provide written documentation and corrective action plans as needed.
• Support QM RN with investigation and research of quality-of-care concerns.

Education

LPN license

Tools

Excel

Data analysis

Job description

Work Shift

Day

Job Category

Risk, Quality and Safety

As an HP LPN Auditor , you will independently triage incoming referrals, manage case assignments, and oversee cases through resolution while ensuring compliance with AHCCCS, Medicare, and Medicaid requirements. This role partners closely with internal teams and external stakeholders to support accurate case management, and regulatory compliance. The ideal candidate is detail-oriented, able to work autonomously, and committed to delivering high-quality outcomes. Comprehensive one-on-one training is provided by experienced investigators to support success in the role.

Your work shifts will be Monday-Friday 8:00am- 4:30pm. This is a remote opportunity. CANDIDATES MUST RESIDE IN THE STATE OF ARIZONA TO BE CONSIDERED.

Please note Banner Staffing Services roles do not offer medical benefits or paid time off accrual.

• These roles are assignment based with no guarantee of hours and assignments can conclude at any time.
• MUST RESIDE IN THE STATE OF AZ.

If this role sounds like the one for you.

POSITION SUMMARY

This position coordinates and performs quality medical record reviews of the ambulatory medical record for PCP's, OBGYN and High Volume Specialists (HVS). This position is also responsible for assisting the QM RN with the investigation and research of quality of care concerns that have been referred to the Quality Management Department for review and resolution. In addition, the position is also responsible for abstracting medical records, analyzing data and importing data to ensure that all contract requirements and UAHN/MHP initiatives are completed successfully and timely.

CORE FUNCTIONS

• Assists in the development of clinical medical record audit tools and processes. Conducts data analysis using Microsoft Excel; Requests, compiles, sorts, prepares, reviews, validates, and analyzes data extracted from ManagedCare.com, TCS, medical records and survey tools using statistically reliable sampling methods.
• Coordinates, retrieves, and performs medical record audits to determine provider compliance with established AHCCCS standards for documentation in conjunction with the re-credentialing process.
• Monitors and tracks Corrective Active Plans (CAPs), in collaboration with the Manager, Supervisor or QM RN and communicates audit results to providers along with education about best practices and recommendations for improvement as outlined in established guidelines.
• Provides written documentation and Corrective Action Plans as directed by the Credentials Committee to providers when necessary, and coordinates communication with the Credentialing Department.
• Reports potential risk or compliance issues identified in the audit process to the Manager/Supervisor of QM. Assists in the development of QM policies and desktop procedures. Provides input and feedback on opportunities for improvement; Aggregates and analyzes medical record audit results on an annual basis for OFR required data. Participates in system-focused analyses in response to error identification.
• Coordinates, collects data and prepares monthly provider profile data reports for the Credentialing Department. Coordinates, abstracts, and assists with the analysis of data from medical records in accordance with HEDIS specifications. Actively works with the HEDIS team to ensure understanding of performance measures, methodology and processes.
• In collaboration with Director, Manager, Supervisor of Quality Management and Information Systems, creates datasets for review by the Quality and Medical Management Administration Staff and other department studies as assigned, including but not limited to setting up database and associated data entry programs, and retrieving data from the database for purposes of analysis or data review.
• Supports the continuous improvement of the department, Medical Management, and UAHP through active participation in strategies to enhance organizational structure and processes. Responsible for working toward achieving full compliance in assigned areas for the annual AHCCCS operation review and complete all assigned work plan tasks.
• This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization.

MINIMUM QUALIFICATIONS

Current, unrestricted State of Arizona LPN license. Two years of experience, preferably in a family practice or pediatric medical office setting, with the ability to travel to all contracted sites, which may necessitate occasional overnight stays.

The ability to function both as a member of an interdisciplinary team as well as the ability to function independently. Excellent verbal and written communication skills and the ability to develop a strong rapport with providers and staff in