Quality Analyst/Auditor- Green Bay, WI - Full Time

Quality Analyst/Auditor Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health—they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success.

Together we are the best place to get care and the best place to give care.

Job Summary

The Quality Analyst/Auditor manages quality-related aspects of insurance contracts to ensure Prevea Health receives negotiated reimbursements for meeting required quality metrics. This position reviews medical records, analyzes payer data, and collaborates with providers and leadership to ensure accurate documentation, compliance, and optimization of quality performance tied to insurance contracts.

What you will do

Review medical records and extract relevant data to meet quality and audit metrics; verify accuracy of documentation and coding. Review reports and data provided by insurance payors; perform audits and medical record validation to ensure accuracy. Assist with implementation of new contracts and programs, ensuring workflows and processes meet contract requirements related to quality metrics.

Develop educational materials and provide guidance to providers and staff related to quality metrics, documentation standards, and contract requirements. Support contract review by analyzing quality-related terms within assigned insurance contracts and amendments; interpret and communicate quality measure requirements and performance thresholds to support achievement of contract goals Prepare audit reports and streamline workflows to meet monthly, quarterly, and annual quality and performance goals.

Monitor assigned contract performance to identify gaps in meeting quality requirements; recommend and support corrective actions as needed. Identify and support opportunities for automation of quality data extraction using EPIC or other data sources. Collaborate with Clinical Optimization Team, Chief Quality Officer, Chief Financial Officer, and Physicians/Clinicians to develop and implement best practices for quality-related workflows.

Education

Qualifications

Associate's Degree Healthcare Administration or Technical Diploma in Healthcare related field Preferred Experience Qualifications 2+ years Healthcare related work experience Required Clinical experience as MA or LPN Preferred Experience with electronic medical records, EPIC, and Microsoft Office Preferred Skills and Abilities Familiarity with quality measures such as HEDIS.

Understanding of medical record documentation and coding guidelines. Knowledge of medical insurance claims processes. Familiarity with insurance contracts. Strong analytical, auditing, and organizational skills. Ability to communicate effectively with providers, leadership, and cross-functional teams. Physical Demands Sit

• Constantly Stand
• Rarely Walk
• Rarely Drive
• Rarely Climb (Stairs/Ladders)
• Rarely Bend (Neck)
• Constantly Gross Manipulation (Hands/Arms)
• Occasionally Twist/Turn (Neck)
• Frequently Twist/Turn(Waist)
• Occasionally Lift/Carry 0-10 lbs.
• Occasionally Lift/Carry 11-25 lbs.
• Rarely Lift/Carry 26-35 lbs.
• Rarely Push/Pull up to 10 lbs.
• Rarely Push/Pull 11-25 lbs.
• Rarely Push/Pull 26-35 lbs.
• Rarely Reach (Above shoulder level)
• Rarely Reach (Below shoulder level)
• Frequently Simple Grasping (Hands/Arms)
• Frequently Fine Manipulation (Hands/Arms)
• Frequently Gross Manipulation (Hands/Arms)
• Occasionally Working Conditions Noise
• Occasionally Travel Requirements 5% Hearing Requirements Hears Whispers < 3 feet
• Constantly Hears Whispers 3-8 feet
• Constantly Vision Requirements Color Discrimination
• Constantly Near Vision (Correctable to Jaeger 2 or 20/40 binocular)
• Constantly Distance Vision (Correctable to Snellen chart 20/40 binocular)
• Constantly Prevea is an Equal Employment Opportunity/Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify