Claims Quality Audit Director jobs in Alaska

Claims Quality Audit Director directs and oversees the operations of the claims quality audit department to follow the audit policies, procedures and regulation. Provides professional knowledge and guidance on technical or procedural problems. Being a Claims Quality Audit Director creates claims audit policies and procedures. May recommend changes in claims processing procedures. Additionally, Claims Quality Audit Director typically Requires a bachelor's degree. Typically reports to top management. The Claims Quality Audit Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Quality Audit Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)

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Director of Quality - Clinical Quality Department
  • Alaska Native Tribal Health Consortium
  • Anchorage, AK FULL_TIME
  • The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction.

    ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.

    Our vision: Alaska Native people are the healthiest people in the world.

    Benefits include:

    • Generous Paid Time Off and holiday schedule with 4 weeks paid vacation per year to start and 12 paid holidays.
    • More than 19 Federal healthcare plans with plans for employee, employee plus one, and employee plus family available. ANTHC covers 80% of all health insurance premiums and 100% of Short-Term Disability, Long-Term Disability, Dental, Vision, Basic Life, and AD&D.
    • 401(a) retirement plan; ANTHC will contribute 3% of your annual compensation to the plan account each year, with up to an additional 5% match with a 6-year vesting schedule.
    • 403(b) retirement savings plan with pre-tax and Roth options. Flexible Spending Accounts for Health Care and Dependent care are also available.
    • Onsite Child Care is available in a brand new education facility.
    • Onsite free gym access. Additional gym, rock climbing wall and salt-water pool available at the Alaska Pacific University for a small fee per semester. Steep discounts on outdoor equipment rentals for your Alaskan adventures!
    • Tuition reductions for employees and their eligible dependents at the Alaska Pacific University.

    or contact Recruitment directly at HRRecruiting@anthc.org.

    Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.


    Summary:

    Works with the appropriate stakeholders and ANMC staff to facilitate the delivery of ever-improving quality clinical care to patients and customers. Focuses on continuous improvement and redesign of processes, utilization, and quality initiatives to enhance and improve clinical outcomes. Supervises departments and staff responsible for Quality Improvement, Infection Control, Data Resources, Risk Management, Patient Safety and Accreditation.

    Responsibilities:

    Working in partnership with all clinicians, provides the focus and leadership necessary for ANMC to rise to the challenges of achieving best practice standards for effective, safe, timely, patient centered, equitable, and efficient care.

    Establishes credibility by building trusting relationships with key stakeholders. Develops strategies to improve clinical outcomes. Delineates specific policies and procedures that can be improved and implemented. Inspires staff throughout ANTHC to support quality initiatives. Develops priorities and focus for quality improvement activities.

    Serves as the working leader for improving clinical performance practices, capabilities, and results; facilitating communication and sharing of best practices information; and fosters understanding and managing performance for guiding planning and opportunities for improvement.

    Ensures the alignment of systems and processes to improve clinical quality. Continuous improvement will be targeted primarily at the interfaces between clinical core business groups and other committees that focus on inter-functional communication, process improvement strategies, process coordination and implementation.

    Implements processes and methodologies for the sharing of best practices that support clinical quality improvement. Develops innovative ways to share best practices across both ANTHC and SCF boundaries. Manages data resources to align and maintain best practices, including the implementation and maintenance of an electronic health record. Manages resources to maintain ongoing readiness and regulatory compliance.

    Facilitates and coordinates redesigning of processes and systems for improvement within the Performance Improvement Department that focus on resource efficiency, quality, and employee satisfaction. Provides assistance to executive leadership to design and operationalize new processes and practices. Coordinate consultants and other change agents as appropriate to plan, deploy, and evaluate best practices and processes for continuous improvement, positive outcomes, and sustainability.

    As a member of the Quality and Performance Team, responsible for teaching, coaching, mentoring, and challenging staff in the use of Quality Management Principles as the preferred method of problem identification and resolution, and improvements.

    Facilitates partnership with Southcentral Foundation (SCF) and maintain a positive work relationship and services with the ANTHC Corporate Office.

    Maintains personal integrity in all aspects of communication and relationship throughout the organization. Be proactive and adept in communicating with peers and staff. Creates opportunities to celebrate the accomplishments of staff, physicians, and peers.

    Provides leadership, direction, and guidance to assigned staff. Develops goals and priorities in conjunction with employees, and assigns tasks and projects. Develops staff skills and training plans. Counsels, trains, and coaches subordinate staff. Implements corrective actions and conducts performance evaluations.

    Performs other duties as assigned.

    Other information:

    KNOWLEDGE and SKILLS

    · Knowledge of Compliance/HIPAA process, regulations, and internal controls.

    · Knowledge of quality improvement tools and methodologies.

    · Knowledge of process improvement methods and measures.

    · Skill in leading and implementing quality improvement initiatives.

    · Skill in working with individuals, multidisciplinary teams, cross-functional groups and internal and external customers.

    · Skill in comprehending complex functions and procedures and to be able to disseminate that knowledge in a clear and understandable format to others.

    · Skill in communicating to people of diverse background, education, and experience including cross-cultural communication skills and ability.

    · Skill in understanding and interpreting financial data, patient population demographics, and patient workload data and trending.

    · Skill in management techniques to enhance subordinate productivity and maintain positive staff morale.

    · Skill in managing effectively through influence. Is adept at creating win-win situations. Is politically savvy and handles complex situations with sensitivity.

    · Skill in promoting cooperation and teamwork. Is inclusive of key stakeholders when making decisions that affect the organization.

    · Skill in communication and relationship building.

    · Skill in building strong teams and cultivating a culture of team work and collaboration. Exhibits warmth and provides clear, direct leadership.


    MINIMUM EDUCATION QUALIFICATION

    A Bachelor’s degree in Healthcare Administration or a related field.


    MINIMUM EXPERIENCE QUALIFICATION

    Non-supervisory - Ten (10) years of Quality experience or related experience.

    AND

    Supervisory - Five (5) years healthcare leadership experience.


    PREFERRED EXPERIENCE QUALIFICATION

    Experience in the Alaska Tribal Health System. Training or experience specific to worksite wellness programs is highly preferred, as is experience with implementation of systems change in worksite settings.


    ADDITIONAL REQUIREMENTS

    Travels frequently within Alaska in small fixed wing aircraft; travels outside Alaska.

  • 10 Days Ago

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Director of Quality Improvement
  • JAMHI Health & Wellness, Inc.
  • Juneau, AK FULL_TIME
  • Description: Under the supervision of the COO the Director of Quality Improvement is focused on primary care and behavioral health service quality. The ideal candidate is an accessible and visible lea...
  • 1 Day Ago

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Audit Manager
  • BDO USA Experienced Career Site
  • Anchorage, AK FULL_TIME
  • Job Summary: The Assurance Manager is responsible for supervising, directing and reviewing the results through the delegation of tasks throughout the planning, field work and “wrap-up” stages of an Au...
  • 21 Days Ago

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Cash Audit
  • Three Bears Alaska Inc
  • Eagle River, AK OTHER
  • Job Description Embark on a thrilling journey with Three Bears Alaska – a dynamic, family-owned grocery store chain that has been an integral part of Alaska's community since 1980. We're on the lookou...
  • 2 Days Ago

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Audit clerk
  • LOOMIS
  • Anchorage, AK FULL_TIME
  • Balance & Audit Clerk Loomis Armored Anchorage, AK, 1205 E Dowling Rd, Anchorage, Alaska, United States of America Req #4573 Friday, March 8, 2024 With a network of nearly 200 branches, Loomis armored...
  • 5 Days Ago

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Claims Processor
  • Highmark Health
  • AK, AK FULL_TIME
  • Description JOB SUMMARY This job is responsible for screening, reviewing, evaluating online entry, correcting errors and / or performing quality control review and final adjudication of paper / electr...
  • 21 Days Ago

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Director of Quality Control
  • Theery
  • Skokie, IL
  • our client is seeking a dynamic and experienced leader to join their team as the Leader of Quality Control. In this role...
  • 3/27/2024 12:00:00 AM

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Director of Quality Control
  • ADAGE INNOVATIONS INC
  • Alexandria, VA
  • Job Description Job Description Benefits/Perks Competitive Compensation Great Work Environment Career Advancement Opport...
  • 3/27/2024 12:00:00 AM

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Director of Quality Control
  • Virbac
  • Bridgeton, MO
  • Experiencing together a unique human adventure Animal health is key to the health of the planet. Working at Virbac means...
  • 3/27/2024 12:00:00 AM

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Associate Director of Quality Control
  • Sern BioScience
  • Bend, OR
  • The Quality Control department seeks an industry leader who demonstrates strong regulatory knowledge and GMP standards t...
  • 3/27/2024 12:00:00 AM

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Director of Quality Control
  • Direct Biologics
  • San Diego, CA
  • Direct Biologics is a market leading innovator and science-based cGMP manufacturer of regenerative biologic products. We...
  • 3/26/2024 12:00:00 AM

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Director of Quality Control/Training
  • Green Home Solutions
  • Mount Airy, MD
  • If you've got an eye for detail, an aptitude for solving problems, and a drive to make sure that you and your teammates ...
  • 3/26/2024 12:00:00 AM

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Director of Quality Control
  • Careerbuilder
  • Decatur, IL
  • The Head of Quality Control will be an instrumental part in the re-opening of our Manufacturing facility in Decatur, Ill...
  • 3/25/2024 12:00:00 AM

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Director of Quality Management
  • Select Specialty Hospital - The Villages
  • Oxford, FL
  • Overview: Critical Illness Recovery Hospital Director of Quality Management At Select Specialty/Regency Hospitals, a div...
  • 3/25/2024 12:00:00 AM

Alaska is the northernmost and westernmost state in the United States and has the most easterly longitude in the United States because the Aleutian Islands extend into the Eastern Hemisphere. Alaska is the only non-contiguous U.S. state on continental North America; about 500 miles (800 km) of British Columbia (Canada) separates Alaska from Washington. It is technically part of the continental U.S., but is sometimes not included in colloquial use; Alaska is not part of the contiguous U.S., often called "the Lower 48". The capital city, Juneau, is situated on the mainland of the North American ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Audit Director jobs
$164,939 to $235,713

Claims Quality Audit Director in Olympia, WA
Based on our compensation data, the estimated salary potential for Claims Quality Audit Director will increase 16 % over 5 years.
December 23, 2019