CareCentrix

  • Accreditation + Audit Analyst II

    Job Locations US-FL-Tampa
    Job ID
    2018-5834
  • Overview

    Partial telecommute options are available for this role.

     

    Accountable to maintain company URAC and NCQA accreditations and to support compliance with customer and legal requirements relating to delegated functions, including utilization management, claims, and credentialing. Support accreditation and customer delegation oversight audit processes by reviewing and developing policies to comply with standards and preparing for and participating in accreditation and customer delegation oversight audits.  Through the ongoing collection and analysis of data, identify and facilitate continuous improvement efforts to ensure compliance with accrediting, customer and legal requirements.

     

    Responsibilities

    • Prepares for and participates in customer delegation oversight audits, including preparation of audit tools and audit files.  
    • Prepares for and participates in NCQA and URAC audits, 
    • Performs internal audits and identifies opportunities for improvement.
    • Develops and delivers training to address improvement opportunities identified through audits
    • Monitors and communicates changes in accrediting standards and works with operational areas to implement changes required due to changes in accrediting standards
    • Drafts policies to ensure compliance with applicable legal and accreditation standards  
    • Works with UM Operations to promote accreditation and customer delegation oversight audit success
    • Facilitates and provides direction to staff regarding accreditation standards
    • Participates in special projects and performs other duties as assigned.  

    Qualifications

    • Bachelor's Degree preferred or minimum of 5 years’ experience in a managed care setting. 
    • Must have excellent interpersonal skills, ability to teach, thorough understanding of URAC, NCQA, CMS and state law standards pertaining to utilization management, claims, and credentialing, project management skills, competent in the use of computers, statistical analysis, data display, auditing, skill with Excel and preferably also with Access.
    • Possess excellent writing and presentation skills.
    • Training or experience in informatics and reports desired.  

     

    CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.

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