Clinical Quality Assurance Auditor
BlueCross BlueShield of Tennessee
full-time
Posted on:
Location Type: Remote
Location: Tennessee • United States
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About the role
- Auditing provider documentation and supporting HEDIS quality initiatives
- Analyzing clinical data to identify gaps and performance opportunities
- Partnering with provider offices to enhance Stars performance
- Ensuring compliance with regulatory and organizational standards
- Supporting provider outreach to strengthen quality measures across the network
- Presenting and communicating audit results to appropriate parties
- Schedule and perform routine facility, practitioner site, and medical record reviews
- Identifying and evaluating areas of exposure, potential problems and liabilities
- Analyze clinical data to improve individual provider compliance with education
- Providing required documents and consulting support for quality and compliance audits
Requirements
- Bachelor’s Degree in Health Care related field or equivalent work experience
- 4 years - Health Care experience required
- 1 year - Managed care experience or experience with Quality Medical Record Review
- Demonstrated presentation and team facilitation skills
- Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
- Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
Benefits
- Health insurance
- Flexible work arrangements
- Professional development
- Paid time off
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical data analysisHEDIS quality initiativesquality medical record reviewcompliance auditsprovider documentation auditingperformance improvementregulatory compliancequality measures enhancementrisk evaluationdata analysis
Soft Skills
presentation skillsteam facilitationcommunication skillscollaborationproblem-solvingorganizational skillsinterpersonal skillsconsulting supportoutreach supportanalytical thinking
Certifications
Bachelor’s Degree in Health CareRegistered Nurse (RN) license