RN Auditor - Waltham, MA, Trumbull, CT or Newark, NJ - Full-time / Part-time

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work. (sm)

Primary Responsibilities:

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  Coordinates internal reviews on denial letters to determine compliance with contractual and regulatory requirements of the State Medicaid programs, while reviewing for efficiencies and effectiveness of procedures



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  Performs internal Quality Control reviews on processes and activities while developing recommendations for improvement



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  Serves as a catalyst for implementing an appropriate risk assessment process designed to identify and correct deficiencies



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  Assists with the coordination of external audits and reviews conducted by our clients or contracting organizations



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  Maintain extensive knowledge of regulatory and applicable accrediting body requirements becoming a Compliance resource for the team



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  Proficient in interpreting benefits, contracts, and medical policy



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  Review denial notice issued by the National Letter team to ensure accuracy and compliance, as well as providing recommendations for improvement, as needed



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  Interact effectively with other departments



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  Maintain knowledge of State rules, contracts, and Federal legislation/regulations as well as UnitedHealth Group guidelines



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  Establish and maintain good working relationships throughout the company to support goals and objectives



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  Demonstrate flexibility, availability, and dependability to conform to position responsibilities

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  RN required



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  Proven analytical and problem solving skills while managing multiple tasks simultaneously



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  Ability to work independently or in a team environment



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  Demonstrated excellent written and verbal communication skills required



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  The applicant should possess a high attention to detail, exceptional documentation abilities, and organizational skills



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  Proven ability to meet critical deadlines consistently, while completing tasks accurately



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  Proven ability to handle multiple tasks simultaneously by working independently, as well as part of a team, in a fast paced environment



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  Excellent computer skills with direct experience in Microsoft Office, Word, and Excel required



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  Bilingual - English / Spanish