Inovalon

  • Delegation Oversight Auditor

    Job Locations US-MD-Bowie
    Requisition ID
    2018-8775
    Category (Portal Searching)
    Legal
  • Overview

    Inovalon is a leading technology company that combines advanced cloud-based data analytics and data-driven intervention platforms to achieve meaningful insight and impact in clinical and quality outcomes, utilization, and financial performance across the healthcare landscape. Inovalon's unique achievement of value is delivered through the effective progression of Turning Data into Insight, and Insight into Action. 

     

    As a Delegation Oversight Auditor you will be responsible for data collection, analyzing and mapping of business processes to ensure that appropriate quality assurance check points are in place, along with conducting audit reviews to gauge performance against established standards and client deliverables.

    Responsibilities

    • Support cross-functional responsibilities in the Delegation Oversight and Auditing team as it pertains to policy and operational audits, credentialing file audits, Personal Health Visit document management audits and case management referrals;
    • Conduct quality monitoring processes on a subset of assigned vendors’ activity for member outreach calls for Personal Health Visits and participate in monthly call calibration sessions;
    • Manage the day-to-day logging, investigating and reporting out of member level intervention complaints for assigned clients;
    • Evaluate processes and procedures to evaluate performance against client commitments and internal performance standards;
    • Maintain day-to-day oversight of tasks for assigned vendors;
    • Participate in the day-to-day credentialing and re-credentialing processes of providers;
    • Ensure all providers maintain compliance with state/federal licensure guidelines, as applicable;
    • Create and/or review and provide feedback on ad hoc reports related to day-to-day tasks; and
    • Proactively assess, promote and implement quality assurance and auditing best practices.

    Qualifications

    • Bachelor's degree or equivalent work experience; 
    • Minimum 3 years prior compliance and/or quality management experience with comprehensive knowledge and understanding of CMS, NCQA and URAC Credentialing, Delegation and Quality Improvement is required;
    • Prior work experience with conducting audits and understanding of auditing methodologies;
    • Prior work experience in the health care industry required;
    • Business analytical skills: process flows, spreadsheets, modeling, procedures, etc.;
    • Strong knowledge of MS Office, including Access, Project, Excel, Visio;
    • Effective verbal and written communication skills; and
    • Ability to multi-task in a fast-paced, team oriented environment. 

     

    Inovalon provides equal employment opportunities (EEO) to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or protected veteran status and will not be discriminated against on the basis of disability. 

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