Quality Assurance Auditor, Health and Compliance

Alliant Health Solutions, Inc.; Columbia (SC); Presencial; USD 65 000 - 85 000; Tempo integral

Resumo da oferta

Alliant Health Solutions, Inc. seeks a Quality Assurance Reviewer in Columbia, SC to join a professional multi-disciplinary team. You will lead quality assurance reviews, monitor policy compliance, and conduct consumer interviews within the SC DDSN program.

Essential duties include on-site reviews, desk reviews, and reporting to providers and SC DDSN. A Bachelor's in a human services field and 3+ years of related experience are preferred, with strong analytical and interpersonal skills and

Qualificações

• Bachelor's degree in a human services field and a minimum of 3 years of related experience with SC DDSN, Medicaid, mental health utilization review, case management, quality assurance, claims auditing, and/or fraud/abuse.
• Strong analytical, organizational, and communication abilities; ability to work independently and travel as needed.

Responsabilidades

• Perform desk reviews using prior findings and initiate case activity logs for on-site reviews.
• Conduct on-site reviews including entrance/exit sessions, staff interviews, and document reviews.
• Notify providers of visits; conduct entrance/exit interviews and report preliminary findings.
• Make recommendations based on professional judgment for compliance with SC DDSN standards and service quality.
• Analyze, interpret, and document review outcomes using the MedGuard system.
• Prepare timely written letters/reports to providers/SC DDSN with findings.
• Review follow-up information and provide recommendations for ongoing compliance.
• Occasionally participate as a panel member to provide professional expertise on standards of service delivery.

Conhecimentos

Clinical knowledge

Organizational skills

Analytical thinking

Communication skills

Interpersonal skills

Travel readiness

Formação académica

Bachelor's degree in social work, sociology, psychology, nursing or other human services degree

Ferramentas

Excel

Word

Descrição da oferta de emprego

Alliant Health Solutions, Inc. seeks a Quality Assurance Reviewer in Columbia, SC to join a professional multi-disciplinary team. You will lead quality assurance reviews, monitor policy compliance, and conduct consumer interviews within the SC DDSN program.

Essential duties include on-site reviews, desk reviews, and reporting to providers and SC DDSN. A Bachelor's in a human services field and 3+ years of related experience are preferred, with strong analytical and interpersonal skills and