• The Outpatient Auditor is responsible for completing quality assurance reviews on internal and/or external outpatient coding specialists or external providers • This role involves validating the coding specialist is accurately abstracting data into appropriate client electronic medical record systems • Responsible for reporting quality results, tracking educational opportunities, and providing educational support and training

Role Description - 收集零售店與市場資訊，指定商品庫存盤點及商品拍照登錄。 - 負責招募商店、專案執行。 - 與樣本商店維持良好合作關係，以降低商店替換率。 - 依規定的行程安排完成資料收集工作並準時將資料傳送回公司。 Qualifications - 須能陌生拜訪並接觸受訪者，口齒清晰，反應靈敏，主動積極、有相關經驗者佳。 - 自備交通工具與駕照：普通小型車、普通重型機車。 - 工作區域以高雄市内爲主。 Requirements - 此職務為外勤工作，不需要固定到辦公室上班。 - 工作經驗：高中及以上。 - 學歷要求：不拘。 Benefits - Flexible working environment - Volunteer time off - LinkedIn Learning - Employee-Assistance-Program (EAP)

Title: Coding Quality Review Auditor - Ambulatory (Remote) Location: Roseville, CA, United States Department: Support Services Job Description: Description Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Performs quality reviews and audits to ensure compliance with DRG validation, ICD-10/PCS, and CPT coding guidelines. Coordinates with department leadership to ensure standards are met in accordance with department and organization policy. Contributes to improving the processes and infrastructure of the department. Demonstrates proficiency in facilitation and interpersonal communication, organizational skills, prioritization of tasks, professionalism, and educating and training as required. Uses in depth understanding of the CQR quality workplan to will promote compliance and awareness of the plan. Acts as a subject matter expert (SME) in national coding guidelines for hospital inpatient, outpatient, and/or Professional fee coding and will ensure compliance with those guidelines along with all company coding policies. Uses performance improvement analyses to improve the accuracy, integrity and quality of patient data, ensure minimal variation in coding practices, and improve the quality of physician documentation within the body of the medical record to support code assignments which results in appropriate reimbursement and data integrity. Job Requirements: Education and Work Experience: - High School Education/GED or equivalent: Required - Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred - Five years' acute care inpatient, outpatient coding experience, and/or professional fee coding: Required - Three years' coding auditing/monitoring experience: Preferred Licenses/Certifications: - Certified Coding Specialist credential (CCS) through AHIMA or AAPC; credential type specific to auditing being performed.: Required Essential Functions: - Performs regularly scheduled quality reviews and audits per departmental policies and procedures (routine, pre-bill, policy driven, targeted, and post-bill) for hospital inpatient, outpatient, and/or professional fee coding. Facilitates the coder audit appeal process, providing rationale and education to the coding team as required. Performs ad hoc quality reviews, such as targeted DRG reviews, and special projects as assigned by management. - Prepares detailed audit reports outlining findings, recommendations, rationale, and corrective actions needed. Facilitates the coder appeal process. Assists team members with coding questions and provide resolution guidance. - Assists in ensuring coding staff adherence with coding guidelines and policy, both internal and vendor teams. Demonstrates and applies expert level knowledge of medical coding practices and concepts. Communicates appropriately with manager and all stakeholders as required. - Identifies and communicates educational opportunities to manager. Maintains working knowledge of workflows, systems, and tools used in the department. Reviews all official data quality standards, coding guidelines, company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current. - Maintains up-to-date knowledge of medical terminology, coding guidelines, quality standards, regulatory changes, etc. that affect the audit process. Assists in creation and maintenance of a positive working environment, including effective communication and setting an appropriate professional example. - Performs other job-related duties as assigned. Organizational Requirements: Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein. About Us Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope Job Info - Job Identification 63823 - Job CategoryAssociate - Locations ONE Adventist Health Way, Roseville, CA, 95661, US - Job ShiftDay Shift - Pay RangeThe estimated base pay for this position is $36.91 to $50.62. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information. - Hiring DepartmentRC Coding - Ambulatory - Shift Length8 Hours

Role Description The Quality Auditor will perform routine and targeted operational quality audits across health plan operations including but not limited to Claims, Grievances and Appeals, Enrollment, Configuration, Provider Data and/or Letters/Materials to ensure compliance with regulatory requirements, internal policies, contractual obligations, and operational standards. This role monitors quality, accuracy, and identifies opportunities for improvements that will enhance member and provider experience. - Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of Claims, Grievances and Appeals, Enrollment, Configuration, Provider Data and/or Letters/Materials standards for assigned business process. - Work assigned cases through SCAN's workflow system, and apply correct status attributes to track and trend issues. Notate cases/audits with required detail to ensure that others understand the status of case/audit and final resolutions. - Work closely with other business units to ensure processing errors are reviewed and corrected. - Follow policies and procedures to maintain efficient and compliant operations; communicate suggestions for improvement and efficiencies to management; identify and report problems with workflows following proper departmental procedures; actively participate in departmental staff meetings and training sessions. - Follow all appropriate Federal and State regulatory requirements and guidelines applicable to SCAN Health Plan operations or as documented in company policies and procedures. - Provide a high level of customer service to internal customers by consistently meeting and/or exceeding team expectations including but not limited to quality, productivity, and attendance. - Escalate appropriate audit issues to management as required and follow departmental/organizational policies and procedures. - Maintain required levels of production and quality standards as established by management. Participate in and support ad-hoc audits as needed. - Contribute to overall department success by participating in department initiatives, effective communication and collaboration with all members of the SCAN team through knowledge and idea sharing, take ownership to identify and report issues to appropriate management staff for resolution and work actively with the SCAN team to improve the support to our Members and Providers. - Contribute to team effort by accomplishing related results as needed. - Actively support the achievement of SCAN’s Vision and Goals. - We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. - Other duties as assigned. Qualifications - Associate’s degree preferred or equivalent experience. - 3+ years complex auditing processing and/or auditing experience in the health plan, healthcare, or managed care organization with experience in Claims, Grievances and Appeals, Enrollment, Configuration, Provider Data and/or Letters/Materials. - Must be proficient in processing/auditing for Medicare and Medicaid plans. - 3+ years’ experience in managed healthcare environment related to Claims, Grievances and Appeals, Enrollment, Configuration, Provider Data and Letters/Materials processing/audit. - Strong organizational, analytical thinking and accounting skills; oral and written communication skills. - Strong knowledge of CMS requirements regarding auditing processing. - Completion of health insurance training and medical terminology or equivalent knowledge through on-the-job training and experience. - Knowledge of health care benefit structures and insurance procedures, as they exist in a Managed Care environment. - Strong PC Skills. Microsoft Office (Word, Excel, Outlook, Teams) are required. Benefits - Base wage range: $25.38 to $36.76 per hour. - Work Mode: Remote. - Annual bonus program. - Robust Wellness Program. - Generous paid-time-off (PTO). - Eleven paid holidays per year, plus 1 additional floating holiday, plus 1 birthday holiday. - Excellent 401(k) Retirement Saving Plan with employer match and contribution. - Robust employee recognition program. - Tuition reimbursement. - An opportunity to become part of a team that makes a difference to our members and our community every day!