Kelly Services Quality Review/Audit Senior Associate in Chicago, Illinois

Kelly Services is currently seeking Quality Review/Audit Senior Associates for a well-known health insurance provider located in Chicago, IL.

Our client is restructuring the area because they have contractual requirements with providers to complete data abstraction. Recent resignations leaving gaps with completing audits

Job Title: Quality Review/Audit Senior Associate

Location: Chicago, IL 60604

Type: Contract

Length: 7/5/18 - 12/29/18

Schedule: Mon - Fri 8am - 5pm

Position requires traveling to provider offices and in-office work to complete documentation. Provider offices are in the Chicago area, suburbs and the city

Pay Rate: $14 - $16 per hour

Primary Function:

Coordinate and ensure that all communication is maximized effectively related to key processes and coordination between the provider’s practice and the health plan, associated with the Pay for Quality Program.

Responsibilities:

  • Participate and coordinate in all medical record audits and assist with communication between the embedded nurse case managers and the practice staff and physicians.

  • Facilitate resolution of any discrepancies found during an audit between the medical record findings and disease management program placement.

  • Maintain the process for ongoing patient chronic disease identification. Communicate to the Health Plan clinical information for review and disease management placement.

  • Maintain process to gather information within the medical record and identify missing standards of care for an office visit/point of care event.

  • Document P4Q measure compliance within the CHS provided web based applications validate claims, lab, and pharmacy data as well as face to face encounters for each member.

  • Maintain an accuracy level of 95% on QA audits to be conducted a minimum of two times per year.

  • Ensure any pertinent point of care information is communicated appropriately. After an office visit, send clinical information to the Health Plan and/or vendor for member communication/calls.

  • Maintain and update treatment alerts and flow sheets for the member within the medical record (paper or EMR) Utilize the CHS provided web based application to set ticklers and follow up for member appointments.

  • Notify the enrollment and/or customer service department via the CHS provided web based application of any changes or anomalies in member record information.

  • Develop and maintain process that encourages all CHS members to receive a minimum of one PCP visit per year.

Apply Today!

If you're interested in the position please send a follow up email (with your resume) to Robv492@kellyservices.com for further consideration. Thank you for your time and I look forward to working with you.

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