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Key Responsibilities:
- Oversee delegated audits related to UM, Credentialing, Claims, Enrollment, and Appeals in coordination with Compliance.
- Act as a subject matter expert on state and national regulatory bodies, aligning policies and workflows.
- Work with leadership on audit activities, corrective action plans, and contract delegation.
Qualifications:
- Five years of experience in audits, policy review, and documentation.
- Bachelor's degree and working knowledge of Knox-Keen, DMHC, and CMS rules.
- Proven ability to communicate process changes and impact to leadership.
Work Environment:
- This is a fully remote position with equipment provided (laptop, docking station, dual monitors).
- Must work PST business hours and collaborate with cross-functional teams.
- Opportunity to contribute to a mission-driven organization focused on quality care.
Dignity Health Management Services
Dignity Health Management Services offers integrated management and business services to healthcare providers, focusing on managed care administrative and clinical services to contain costs and improve quality. It is part of CommonSpirit Health, a large health system with a mission-driven culture centered on community and patient care.