Behavioral Health Clinical Quality Audit Analyst Sr
Core
Conducts on-site external quality audits (NCQA, AAHC, EQRO) and performs medical record chart reviews for behavioral health appeals and denials to ensure compliance and quality outcomes.
Role type
Senior Behavioral Health Clinical Quality Audit Analyst
Builds
Quality management reports and member/provider education interventions
Domain
Healthcare / Behavioral Health / Managed Care
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Behavioral health clinical licensure (NY), medical record review, quality improvement, risk management, utilization review, data analysis, trend analysis, HEDIS interventions
Preferred skills
Process improvement, implementation of quality studies, member outreach, provider education
Technologies
NCQA, AAHC, EQRO, HEDIS
Responsibilities
Completes member-facing HEDIS interventions telephonically; performs monthly/quarterly/annual medical record chart audits; analyzes data to prepare quality management reports; defines improvement opportunities through trend analysis; assists in implementation of behavioral health outcomes improvement interventions; travels to worksite as necessary
Seniority
Senior, hands-on IC
