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Anthem QI Specialist - Hanover, MD - PS22258 in Eagan, Minnesota

QI Specialist - Hanover, MD - PS22258

Location: United States

Requisition #: PS22258

Post Date: Aug 15, 2019

Your Talent. Our Vision. At Anthem, Inc . it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Location: This is an office based position in the Hanover, MD health plan office.

The QI Specialist is responsible for performing and/or documenting quality reviews bases on departmental procedures and contributes to standardizing the quality review approach to be in compliance of contractual, State, and Federal requirements. This position manages functions pertinent to NCQA Accreditation surveys and state External Quality Review audits and other tasks for the East Regional health plans.

Primary duties may include, but are not limited to:

-Focuses on identifying, recommending and implementing a standardized approach to performing and scoring quality audits.

-Examines and evaluates the accuracy of transactions processed by reviewing policy, procedure and manual input in accordance with guidelines.

-Tracks, trends and reports audit results to management.

-Identifies and communicates training issues and assists in developing corrective action plans.

-Runs and monitors monthly reports from database to identify and/or correct any incorrect data.

Requires a High School diploma or GED; 5 years of experience in health care, medical terminology and coding, 2+ years of related experience; or any combination of education and experience, which would provide an equivalent background.

-Experience working in a healthcare environment required.

-Knowledge of Maryland State regulatory standards and NCQA experience is highly recommended.

-Knowledge and understanding of Quality Management is a must.

-Computer skills: MS Office (Work, Outlook, Excel).

-Professional, organized, attention to detail, time management skills required.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.

Anthem, Inc. is ranked as one of America’sMost Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.