Quality Audit Analyst

Banner Health•Bismarck, ND

3d•Hybrid

About The Position

Banner Plans & Networks (BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is to reduce healthcare costs while keeping our members in optimal health. BPN is known for its innovative, collaborative, and team-oriented approach to healthcare. We offer diverse career opportunities, from entry-level to leadership positions, and extend our innovation to employment settings by including remote and hybrid opportunities. As a Quality Audit Analyst, you will be a vital part of the Health Plan Quality Management Team. This role focuses on Behavioral Health chart reviews, policy and procedure evaluations, onsite agency audits, and providing technical assistance to ensure our contracted providers meet regulatory and contractual standards. This role offers a strong opportunity to grow within a managed care organization and develop valuable experience in quality management and process improvement.

Requirements

Candidates must be self motivated, detail oriented, and possess strong computer skills, including proficiency in Microsoft Word, Excel, Outlook, Teams, and comfort navigating various EHR systems.
Success in this role requires the ability to work independently, manage time effectively, and meet daily and weekly productivity metrics.
Bachelor’s degree or equivalent working knowledge in the field of Behavioral Health related fields.
Two to four years of relevant experience in quality management, process improvement, project leadership, organization/time management skills, data collection/analysis, client relations, program development, streamline processes, project evaluation, budget management, training and development.

Nice To Haves

AZ Board of Behavioral Health Licensing and/or CPHQ
Additional related education and/or experience preferred.

Responsibilities

Independently conduct remote and onsite audits of contracted Behavioral Health Agencies, including comprehensive medical record reviews, policy and procedure assessments, and verification of regulatory compliance.
Initiate and coordinate audit scheduling with agencies and maintain consistent communication using virtual tools.
Provide real time feedback and technical assistance to agencies to help them meet or maintain compliance and improve documentation practices.
Compile detailed audit reports outlining findings, corrective actions, and quality improvement recommendations.
Navigate a variety of Electronic Health Record systems to locate, review, and assess clinical documentation.
This position will be responsible for activities involving quality management and compliance with applicable regulatory requirements (AHCCCS, Banner Health Plan, Arizona Complete Care Contract ).
Responsible for implementing and monitoring program providers, applicable regulatory and statutory requirements, and defining quality requirements for development of audit tools based on ACC Contract.
Coordinate and educate quality guidelines and performance measures with providers.
Assist in the root cause analysis and any associated corrective and preventive action(s) in response to provider audits.
Conduct audits, including risk assessments and tracks and trend results of medical record reviews creating audit finding reports and approval of proper corrective and preventive actions, while providing technical assistance and training to providers and staff in methodologies and tools of continuous quality improvement.
Close out audit findings while ensuring timely resolution of investigations and associated corrective actions.
Uses best practices and knowledge of internal or external business challenges to suggest improvements to services, processes or products.
Solves complex problems. Takes a new perspective using existing solutions.
Interprets customer needs, assesses requirements and identifies solutions to non-standard requests.
Makes decisions within approved operating plans and objectives and within functional policies and precedents. Determines how and when to achieve results.