Anthem Quality Improvement Specialist - 80% in Fresno office and 20% in Visalia office and local travel - PS6845 in Fresno, California

Quality Improvement Specialist - 80% in Fresno office and 20% in Visalia office and local travel - PS6845

Location: Fresno, California, United States

Field: Business Support

Requisition #: PS6845

Post Date: Jul 23, 2018

Your Talent. Our Vision . At Anthem Blue Cross , a proud member of the Anthem, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care . This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Quality Improvement Specialist – 80% in Fresno office and 20% in Visalia office, CA with travel

Responsible for performing and/or documenting quality reviews bases on departmental procedures and contributes to standardizing the quality review approach to be in compliance of contractual, State, and Federal requirements. Primary duties may include, but are not limited to:

  • Focuses on identifying, recommending and implementing a standardized approach to performing and scoring quality audits.

  • Examines and evaluates the accuracy of transactions processed by reviewing policy, procedure and manual input in accordance with guidelines.

  • Tracks, trends and reports audit results to management.

  • Identifies and communicates training issues and assists in developing corrective action plans.

  • Runs and monitors monthly reports from database to identify and/or correct any incorrect data.

  • Local travel up to 50%. Occasional overnight travel may be required.

Qualifications:

  • Requires a High School diploma or GED; 5 years of experience in health care, medical terminology and coding, 2-3 years of related experience; or any combination of education and experience, which would provide an equivalent background.

  • Strong computer/application skills required.

  • BA/BS in healthcare field preferred.

  • Any clinical related licensure such as CMA, LVN/LPN, RN and etc. preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.