Medical Management Auditor

Centene

Job Details

Location: Charlotte, Mecklenburg County, North Carolina, USA Posted: Nov 10, 2019

Job Description

Position Purpose: Responsible for the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes

Develop and maintain the audit process and tools related to: authorizations, appeals, quality events, and case management in CCMS; interrater reliability related to InterQual; and data entry into the credentialing subsystem

Develop and maintain the audit schedule

Audit staff as outlined in the system auditing policies

Train audit staff at the health plan in the use of audit process and tools

Facilitate compliance with the auditing process

Act as a consultant related to system auditing to others in the unit, department and health plan

Work with staff to identify and resolve authorization load error report system problems

Coordinate auditing outcomes with the Trainer to identify, develop and publish corrective actions/educational material related to audit errors

Coordinate auditing outcomes and system maintenance with the Sr. Clinical Systems Specialist to resolve or enhance clinical systems

Ability to travel

About Centene

Centene is a multi-line health care enterprise offering Medicaid managed care and specialty services.

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