Job Description
Job Description
POSITION SUMMARY
Reports to Compliance Manager. The Audit Analyst is responsible for UM reporting, audits, assisting with programing, assisting and informing the VP, Operations of any barriers that may preventing tasks from being completed in a timely and efficient manner. Individual must be able to execute effective communications verbally and in writing, maintain patient confidentiality, and promote departmental and organizational goals.
RESPONSIBILITIES-DUTIES
· Schedules and prepares for CM/UM/QM audits
· Manages audit calendar and excel schedule
· Runs/Manages all reports as listed in the P&P
· Assist Compliance Manager, Quality Manager, and Director of Care Management to eliminate CAPs and/or operationalize process improvement techniques for better outcomes.
· May assist with automating reports
· Maintains confidentiality of all members and medical/clinical information
· Performs as necessary to any departmental changes, workload and/or emergencies
· Has understanding of Policies/Procedures
· Letter programs to ensure templates are accurate per Health Plan including but not limited to new and update information from ICE Website
· Ensures the privacy and security PHI (Protected Health Information) as outlined in AMM policies and procedures relating to HIPPA compliance
· Performs other duties as directed by Compliance Manager
· Back up support for managing the Audit Manager application for UM issues
· Back up support for creating denial letters with 8th grade language requirement
EDUCATION AND EXPERIENCE REQUIREMENTS
· One years' experience in a physician office or clinic preferred or IPA/Group UM or CM department Coordinator preferred. But individuals with BA degree from recognized university will be considered and trained.
· Medical terminology training, medical or other healthcare related experience preferred.
· Must be able to communicate both orally and in writing.
· Ability to apply common sense, to read and comprehend simple instructions to carry out detailed written and/or oral instructions.
· Must be able to efficiently prioritize multiple high priority tasks.
· Must have the ability to work independently and be organized with minimal supervision.
· Must maintain strict confidentially of all patient information and IPA business.
AMM BENEFITS
When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:
- Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
- Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
- Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
- Work-Life Balance: Generous PTO, 40 hours of sick pay, and paid holidays to enjoy life outside of work.
- Career Development: Tuition reimbursement to support your education and growth.
- Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!