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ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
InterQualMCGUtilization ManagementCase Managementmedical claimsbilling systemspayer reimbursement policiescoding terminologycurriculum designtraining measurement
Soft Skills
presentation skillsindependent thinkerlogical thinkingstrategic thinkingattention to detaileffective communicationpositive influenceadministrative skillsorganizational skillsmultitasking
Tools & Technologies
R3CATWordAccessExcelPowerPoint
Certifications & Qualifications
RN LicenseCase Management Certification
Industry Keywords
healthcare auditingmedical audit activitiesaudit accuracy measuresQuality Assurancecritical careICUEmergency RoomCath LabMed Surgtraining design
About the role
Key responsibilities & impact- Assess job-specific needs and develop technical training plans with clear business objectives
- Select training/instructional methods and procedures appropriate for the situation
- Deliver specific training sessions, including using suitable delivery methods such as classroom, online, and webinar
- Identify the development needs of others and coach, mentor, or otherwise assist others with improving their knowledge skills
- Provide support to the CCV audit team members; assist with orientation of new members as needed
- Promote audit accuracy measures by training/educating and mentoring the auditor and providing documented and validated findings
- Conduct or arrange for ongoing technical training and personal development classes for staff members
- Integrate healthcare auditing principles and use objectivity in the performance of medical audit activities and reviews
- Provide feedback on reviews to the Quality Assurance Manager as indicated
Requirements
What you’ll need- Associate or Bachelor's degree in nursing
- RN License (active/unrestricted in state of residence)
- Case Management Certification (preferred, but not required)
- 5 to 7+ years of working with InterQual/MCG (Inpatient vs Observation)
- Background in Utilization Management and/or Case Management
- Critical Care background: ICU, Emergency Room, Cath Lab, Med Surg
- 5 to 7+ years of working with a broad knowledge of medical claims, billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology
- Requires expert level knowledge of Interqual and/or MCG criteria
- Strong presentation skills
- Independent thinker, logical, strategic, with a high focus and attention to detail
- Effective communication and presentation style (written and verbal) with proven ability to positively influence behavior and outcomes
- Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects
- Competent administrative and organizational skills, ability to multitask, set priorities, and meet deadlines
- High level of proficiency with all audit technology i.e., R3, CAT, etc.
- Proficiency in Word, Access, Excel, PowerPoint and other applications
- Excellent written and verbal communication skills
Benefits
Comp & perks- Health insurance
- Dental insurance
- Vision insurance
- Disability insurance
- Life insurance
- 401(k) savings plans
- Paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year
