Your Talent. Our Vision. At Simply Healthcare, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, 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.?
This position can me in the Miami FL office, or remote within 1 hour of any Anthem office in the United States.
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.
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.
Daily management of performance improvement groups.
Provides support for QM project tracking and project status reporting.
Prepares performance reports, such as PIP, QIP, and CCIP.
Assists in recording of workgroups, schedule meetings, distribute materials, record and transcribe meeting minutes as needed.
Organizes workflow and supports quality staff in order to meet deadlines.
Proofread and edit materials.
Conducts research for QM projects as assigned.
Requires a High School diploma or GED.
BS degree preferred, or Master's in healthcare related field.
3 years of experience in health care, medical terminology and coding; or any combination of education and experience, which would provide an equivalent background.
Licensed LPN or LVN is a plus.
Experience in data analysis is preferred.
Experience in quality improvement or quality management, or quality management certification is preferred.
Experience in Microsoft Office 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 careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
Internal Number: PS25401
About Anthem Inc
At Anthem, Inc., there are many ways to make a difference. Here, the skills and passions of thousands come together, creating an impressive force with the power to change lives and the future of health care.