PROVIDER NETWORK AUDIT QUALITY jobs in UNITED STATES, United Kingdom

We are the leading provider of professional services to the middle market globally, our purpose is to instill... Risk and Controls Practice we frequently work as or alongside a client’s internal audit function, the chief risk officer...

Operations / Buyer. Prepare parts to be stored to prevent handling damage prior to shipment. Provide quality audit of product...Job Description Quality Inspector The Quality Inspector is responsible to follow standard work instructions...

and programs Responsible to support targeted quality audit projects. Report results and make recommendations e.g., training... as an Advocate for, and support, the business by serving as a quality champion through measuring and monitoring the quality...

and ancillary providers based upon the companies' relationship, volume and market sensitivity. Performs audits and examines provider... prior to contract renegotiations and examines provider contracts to identify underpayment and/or potential overpayment...

with financial, operational and quality objectives to include: provider network development and expansion, network design, network...Summary: The Senior Director of Provider Network Strategy and Management is responsible for developing, implementing...

contract agreements, and maintains provider network listings Partnership with Quality and Compliance team on the establishment... of mock audits in preparation for future State and CMS audit readiness Support provider network administration, including...

provider demographic information, financial data, quality reports, and special project data. The ideal candidate will assist... the network team in preparing for monthly IPA meetings. The ideal candidate will also have knowledge of provider contracts...

network and coordinate with staff across the larger Quality Management Division as well as BHSD, and the BHSD provider network... the Quality Assurance (QA) Chart Audit Team. This Program Manager II (PM II) position will be organized in the...

Network team, applies in-depth knowledge of health care provider contracts and provider data, network operations, and data... audits to support the maintenance and growth of a regional health care provider network that meets or exceeds accessibility...

. Provides enrollment assistance/support to Network provider members for nondelegated health plans as needed. 6. Supports new... management including: a. Network provider membership profiles within Network’s data management tool. b. Updates external...

and other resources, recruits individual, group and/or organizational providers to meet network adequacy standards and assure quality... with all areas of organization to coordinate network management and network administration responsibilities. Assesses network needs...

strategy function built on advanced market and provider intelligence and analyses to drive strategic network decisions..., such as network pricing/configuration, credentialing, provider engagement, and general department operation functions...

. They must continually access the composition and performance of the provider network. This includes primary care incentive monitoring... we are providing a quality network and meeting HEDIS/NCQA requirements. The Senior Network Representative works closely with the Sales...

quality control reviews of audit work products. Prepare accurate and descriptive audit work papers and reports through..., or veteran status. I. Job Summary The Audit Analyst II performs a wide range of financial, operational and compliance audits...

of quality control compliance for pharmacy provider enrollment; pharmacy provider credentialing and contract audit sampling... with a multi-level audience. Detailed Responsibilities: Quality Control Pharmacy Provider Network - This position...

, contracting, network management, operations, billing, stop-loss, claim and performance auditing, compliance, and quality standards...We are looking for an experienced audit expert and leader with technical acumen that can deliver on Risk Strategies...

-Technology Audit Capital One’s Audit function is a dedicated group of professionals focused on delivering top-quality assurance... services to the organization’s Audit Committee. Audit professionals are experienced, well-trained and credentialed, and operate...