CTG MEDICAL MANAGEMENT AUDITOR in Atlanta, Georgia

Title: MEDICAL MANAGEMENT AUDITOR

Location: US-GA-Atlanta

Job Number: 17203576

Medical Management Auditor

Our client in the healthcare industry has an immediate opportunity for a full time Medical Management Auditor in Atlanta, GA. This is a full time, direct placement opportunity!

Our client is now one of the largest providers of Medicaid, Medicare Advantage, and other government-sponsored and commercial programs in the country. They provide access to affordable healthcare to more than 11 million members across the country.

This is a great opportunity to work with one of the fast growing Fortune 500 companies that has a multi-line healthcare enterprise that provides services to government healthcare programs. If you are selected for this opportunity you will be surrounded by colleagues who are dedicated to meeting their own high standards, to inspiring their teammates and to making a positive impact on under-insured and uninsured individuals. Our client’s employees are fast, agile, customer-focused multi-taskers with a commitment to implementing the latest technologies. If these same things get you excited, we hope to hear from you.

Responsibilities:

Responsible for the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes.

  • Develop and maintain the audit process and tools related to: authorizations, appeals, quality events, and case management in CCMS; interrater reliability related to InterQual; and data entry into the credentialing subsystem.

  • Develop and maintain the audit schedule.

  • Audit staff as outlined in the system auditing policies.

  • Train audit staff at the health plan in the use of audit process and tools.

  • Facilitate compliance with the auditing process.

  • Act as a consultant related to system auditing to others in the unit, department and health plan.

  • Work with staff to identify and resolve authorization load error report system problems.

  • Coordinate auditing outcomes with the Trainer to identify, develop and publish corrective actions/educational material related to audit errors.

  • Coordinate auditing outcomes and system maintenance with the Sr. Clinical Systems Specialist to resolve or enhance clinical systems.

  • Ability to travel.

Qualifications:

  • Bachelor’s degree in related field or equivalent experience.

  • 3 years of related experience.

License/Certification: Current state nursing license. Valid driver’s license and insurance.

To Apply:

To be considered please immediately apply to this requisition using the link provided. For additional information please contact Sara Wade at sara.wade@ctg.com or 716-882-8000 x4908. Kindly forward to any other interested parties- thank you!

Qualifications:

CTG is the most reliable IT services provider, built on 50 years of meeting our commitments to make technology work for clients and deliver real business value. CTG provides industry-specific IT strategy, services, and solutions that address the business needs and staffing challenges of clients in high-growth industries, including major technology companies, large corporations, and government entities located in North America and Western Europe.

CTG's greatest asset is its people, and as such we are committed to providing employees programs and processes to support their performance, hone their skills, and advance in their careers. This commitment is reflected by CTG being named a Best Places to Work Company by Modern Healthcare (since 2013) in North America, and a Best Places to Work Company in the United Kingdom (2013), Belgium (since 2007), and Luxembourg (since 2011).

CTG will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of all applicable local, state, and federal laws.

CTG is an Equal Opportunity/Affirmative Action Employer and strong advocate of workforce diversity. Minority/Female/Sexual Orientation/Gender Identity/Disability/Veteran.

Job: Healthcare & Hospital Implementations - Health Insurance