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  • 2311 22nd Street
    Oak Brook, IL 60523

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Internal Market Auditor

Independent Living Systems • Oak Brook, IL

Posted 2 months ago

Job Snapshot

Full-Time
Experience - 2 years
Degree - Graduate Degree
Managed Care, Healthcare - Health Services
Health Care, Nurse

Job Description

POSITION DETAILS

TITLE:   

Internal Market Auditor

CODE/GRADE: 

STATUS: 

Full Time

REPORTS TO: 

Manager Internal Market Audit

INITIAL DATE:

March 25, 2019

REVISION DATE:

DEPARTMENT: 

LTC Illinois

POSITION SUMMARY

Responsible for using a variety of audit tools to monitor compliance with Federal and State contract requirements for members receiving waiver services Summarizes and communicates findings to the appropriate staff and reports on completed remediation actions.

REQUIREMENTS FOR ALL POSITIONS 

* Ability to work and meet deadlines

* High level of accuracy (quality of work)

* Computer Literacy

* Able to multitask daily assigned duties

* Ability to work in a fast-paced environment 

POSITION RESPONSIBILITIES AND ACCOUNTABILITY

Performs functions as a professional member of the organization, including but not limited to:

* Reviews documentation in records using a variety of audit tools to monitor compliance with Federal and State contract requirements for members receiving waiver services

* Summarizes and communicates findings to the appropriate staff for remediation

* Monitors and reports on completed remediation actions

* Works one on one with staff to address identified issues with documentation

* Analyzes and monitors clinical documentation to identify trends and recommend improvements, produces reports based on findings 

* Attends and participates in monthly and ongoing trainings 

Job Requirements

Qualifications

* 2 years’ experience with field case management, clinical auditing and/or healthcare experience 

* Master’s in social work or Bachelor’s, Nursing (RN) preferred

* Demonstrate proficiency with Microsoft Office Applications (Word and Excel)

* Knowledge of software a plus 

* Knowledge of State and Federal contract requirements for providing Care Coordination to Waiver members in the state of Illinois a plus.  

Knowledge. Ability. Skills, and Experience

Good organizational skills. 

Must be flexible and willing to meet deadlines.

Good interpersonal and verbal communication skills.

Strong analytical and problem-solving skills.

Ability to self-manage in a fast -paced, detail -oriented environment; manage multiple priorities in

challenging environment.

Standard Requirements

1.    Supports the Mission, Values and Vision of the company.

2.    Maintains confidentiality of company information and member personal health information (PHI) in accordance with HIPAA privacy and security regulations.

3.    Complies with current law to provide a work environment free from sexual harassment and all other illegal and discriminatory behavior.

4.    Conduct that follows the Standards of Conduct booklet.

5.    Promotes a positive work environment.

6.    Adheres to the company's conduct code and professional performance standards.

7.    Sets an example for others by own self-discipline and behavior.

8.    Assumes responsibility for job performance. Seeks other work when own tasks are complete.

9.    Cross trains in other areas as requested. 

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