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Claims Auditor
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Full-time
- City/StateDoral, FLOverviewWork ShiftFirst (Days) (United States of America)AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Claims Auditor in Miami and/or Gainesville, Florida.
- Applies quantitative and qualitative analysis, maintains data integrity, and conducts quality improvement studies to support decision making, barrier analysis and implementation of interventions.
- Note: Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind.
- Keywords: Talroo-Health Plan, #INDEED, Auditing, Claims,Job SummaryExpected to work closely with the Manager, other clinical and QI staff to assure the overall success of the Healthcare Effectiveness Data and Information Set (HEDIS) Project, appropriateness of care and other QI Projects as assigned.
- Primarily responsible for conducting medical record reviews, data entry and abstraction of data for HEDIS measures, appropriateness of care and other quality initiatives to meet regulatory and contractual requirements for the health plan.
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