Claims Quality Auditor audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Being a Claims Quality Auditor makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Additionally, Claims Quality Auditor typically reports to a supervisor or a manager. The Claims Quality Auditor gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Quality Auditor typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
JOB SUMMARY:
Provide quality and patient safety consulting, analysis and improvement facilitation for staff and leaders throughout the Hospital. Develop, implement, and improve programs to establish and maintain Quality and Patient Safety standards of care provided to patients. Research, collect and analyze internal and external data for decision making. Serve as a subject matter expert regarding quality and patient safety initiatives and significant event management. Ensure that goals are in alignment with the Health System’s Patient Safety and Performance Improvement plan, strategic priorities and regulatory and accreditation requirements.
Minimum Qualifications:
Preferred Qualifications:
ESSENTIAL JOB FUNCTIONS
Salary Range:
Actual salary commensurate with experience.
Equal Employment Opportunity
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.
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0 Claims Quality Auditor jobs found in Galveston, TX area