Clinical Audit Coordinator

Coordinate clinical audits and staff training to ensure CMS compliance and data quality in managed care; audit staff and vendor partners per CMS guidelines, administer audit tools for prior authorizations and star measures, and develop training programs.

• auditing staff and vendor partners per CMS guidelines
• identify and resolve data/reporting errors and present findings to management
• administer audit processes and tools for prior authorizations, appeals, quality improvement, star measurement, inter-rater reliability and data entry
• assess training needs and develop training programs including training aids
• maintain training records and participate in Quality and Advisory committees

Healthcare audit environment focusing on CMS guidelines and data reporting; training delivery and records management; collaborative with management and committees.

The ideal candidate is a mid-level audit professional with a pharmacy technician background in managed care and healthcare, skilled in CMS-guidelines-driven audits, data quality, and staff training.

Preferred