Prospective Chart Review Quality Auditor-1

4 weeks ago

Bengaluru, India Agilon Health Full time

Company:
AHIPL Agilon Health India Private Limited

Job Posting Location:
India_Bangalore

Job Title:
Prospective Chart Review Quality Auditor-1

**Job Description**:

- Performs audits of pre-visit medical record reviews to identify chronic conditions reported in prior years and conditions that lack supporting documentation.
- Evaluates suggestions or clinical alerts presented by Prospective Chart reviewers, ensure that these suggestions meet specificity requirements to support clinical indicators and in compliance with Risk Adjustment documentation standards.
- Conducts review and communicates feedback to professionals such as Clinical Chart Reviewers and third-party vendors.
- Responds to questions submitted by Prospective Chart reviewers.
- Document detailed audit findings including all errors and missed opportunities in the Prospective chart reviews.
- Correlate activities, processes and HCC results/ metrics to evaluate outcomes.
- Assist in developing workflows, curriculum and policies and procedures related to the Pre-visit Medical Record review team.

Other Job Functions:

- Understand, adhere to, and implement the Company’s policies and procedures.
- Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.
- Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
- Engage in excellent communication which includes listening attentively and speaking professionally.
- Set and complete challenging goals.
- Demonstrate attention to detail and accuracy in work product.

Required Qualifications:
Minimum Experience
- 2+ years of clinical experience required
- 5+ year of chart review and medical coding/auditing experience required
- Advanced level of clinical knowledge associated with chronic disease states required

Education/Licensure:

- Medical doctor or Nurse required
- Coding Certification through AHIMA or AAPC required
- CPC or CPMA preferred

Skills and Abilities:
Ability to be a team player and exercise initiative in responding to provider requests and concerns in a helpful and courteous manner Provider contracting and customer service techniques General understanding of the health care industry, ideally the provider relations field-desired Excellent interpersonal and telephone communication skills are required Exercise attention to detail; ability to provide accurate data entry Ability to work under pressure with mínimal supervision, multi-task, complete projects in a timely fashion and meet deadlines a must Excellent analytical, problem solving and organizational skills a must.
_Language Skills:_ Strong communication skills both written and verbal to work with multiple internal and external clients in a fast-paced environment
_Computer Skills: _Ability to create and maintain documents using Microsoft Office (Word, Excel, Outlook, PowerPoint)

**Location**:
India_Bangalore

  • Prospective Chart Reviewer

    1 month ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer - 1 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-1

    1 month ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-1 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-1

    4 weeks ago

    Bengaluru, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-1 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer

    2 months ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer

    2 months ago

    Bengaluru, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-18

    1 month ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-18 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-12

    1 month ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-12 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-17

    2 weeks ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-17 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-10

    1 month ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-10 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-14

    1 month ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-14 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-2

    1 month ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-2 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-15

    1 month ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-15 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-11

    5 days ago

    Bengaluru, Karnataka, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-11 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-13

    1 month ago

    Bengaluru, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-13 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Prospective Chart Reviewer-3

    1 month ago

    Bengaluru, India Agilon Health Full time

    Company: AHIPL Agilon Health India Private Limited Job Posting Location: India_Bangalore Job Title: Prospective Chart Reviewer-3 **Job Description**: Essential Job Functions: - Performs pre-visit medical record reviews to identify chronic conditions reported in prior years - Identify diagnoses that lack supporting documentation - Prioritizes clinical...

  • Quality Auditor

    1 month ago

    Bengaluru, India Wyzmindz solutions pvt ltd Full time

    **WORK FROM BANGALORE OFFICE ONLY** **Quality Auditor Profile** 1.1. Graduate or diploma holder. 1.2. Minimum 6 months of work experience as a Quality Auditor 1.3. Customer service oriented. Should have prior knowledge of customer care processes and techniques 1.4. Keen eye for detail 1.5. Should have good aptitude for fact finding 1.6. Excellent...

  • Quality Professional

    4 weeks ago

    Bengaluru, India Siemens Healthineers Full time

    **Responsibilities**: - Support the audit program manager in definition and implementation of comprehensive audit programs and audit methodologies to effectively address identified risks - Interact with stakeholders at all levels in developing comprehensive audit plan and execution of planned audits - Perform audits for the various products /suppliers...

  • Process & Quality Auditor

    1 month ago

    Bengaluru, India JB Consultants Full time

    We are hiring for Executive - Process & Quality Auditor. Please find below the JD for your reference. JOB DESCRIPTION: - Core Areas: Process Auditing, Process Excellence, Continual Improvements, Driving Kaizen Qualification: Graduate, B.E/B.Tech, 2-3 years experience, ISO 9001, Six Sigma Yellow Belt preferred. Skills Required: Proven experience as an...

  • IT Auditor

    2 months ago

    Bengaluru, India Northern Trust Corp. Full time

    The Auditor, Information Technology (IT) is responsible for conducting and documenting routine audit examinations throughout Northern Trust Corporation. The role is a direct report to the Audit Team Lead, IT or Audit Manager, IT, and is responsible for completing the audit in accordance with stated budget, timeframes, and Department Policies and Standards....

  • Auditor

    2 weeks ago

    Bengaluru, Karnataka, India Philip Morris International Full time

    1.Purpose of the JobWith PMI's journey towards a smoke-free future and a consumer-centric organization, the company faces new opportunities and risks. To safeguard the company's business objectives, ensure its delivery against strategic opportunities, and protect the company against emerging uncertainties, a highly professional and industry-leading risk...