Clinical Operations Specialist
3 weeks ago
Solid Lyndelle Manpower Services Inc. seeks a skilled Clinical Auditor to join our team. Below are the key responsibilities and requirements for this role.
Key Responsibilities:
- Perform regular audits of clinical practices, patient records, and healthcare processes.
- Analyze audit findings and data to identify trends, patterns, and areas of risk.
- Monitor the effectiveness of implemented changes and provide ongoing support.
- Ensure that the organization complies with all relevant regulatory requirements.
- Develop educational materials and resources to support ongoing staff development.
Requirements:
- Registered Nurse with CIC/CCS certification and prior auditing/DRG experience preferred.
- Experience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferred.
- Possesses knowledge of healthcare claims payment policy and processing – specifically CMS, Medicaid regulations, ICD-10 CM & DRG Expert, etc.
- Practical clinical experience working in a hospital/office or nursing home.
- Possesses excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency.
- Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.
Working Conditions:
- This position will be working with a solutions and analytics company.
- Working Set-up: Onsite
- Mondays to Fridays.
- Complete details will be provided by our Recruiters.
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