Advanced Medical Management, Inc. · 3 months ago
Clinical Audit Manager
Long Beach, CA
Full-time
Onsite
Mid, Senior Level
$88K/yr - $92K/yr
4+ years expAdvanced Medical Management, Inc. is seeking a Clinical Audit Manager who will ensure compliance with reporting deadlines set by health plans and manage all audit processes. The role involves preparing regulatory reports, analyzing data, and implementing corrective action plans to enhance operational efficiency and compliance within the organization.
Health CareHospital
Responsibilities
Prepares and coordinates the completion of complex regulatory and compliance reports for submission
Assists in audit preparations, analyzes information, identifies deficiencies, and tracks corrective action for completion. Processes additional data into the system, ensures that data is processed and researches any interruptions to the process
Query, analyze, and interpret data for ad hoc analyses
Participates in quality assurance process for all new department related system/application/process changes
Ability to understand, work with and organize data from various systems and databases: facts, figures, narratives, and data analysis
Demonstrate attention to detail and accuracy in work product. Support all levels of claims staff regarding Medicare Commercial, and Medi-Cal, adjudication and coding rules and requirements
Locate and download all coding sources for system updating
Ensures all reporting instructions (how to generate) are updated and listed in the corresponding P&P
Assist UM Manager, Director of Clinical Operations to eliminate CAPs and/or operationalize process improvement techniques for better outcomes
May assist with automating reports
Performs as necessary to any departmental changes, workload and/or emergencies
Understands the UM and CM Departments’ Policies/Procedures
Ensure templates are accurate per Health Plan including but not limited to new and update information from ICE Website
Ensures the privacy and security PHI (Protected Health Information) as outlined in AMM policies and procedures relating to HIPPA compliance
Develop strategies to meet goals
Set goals and objectives for the team/department
Performs other duties as directed by Vice President of Operations
Qualification
Required
4+ years of experience within an MSO, IPA or Health Plan environment
Must be highly organized and able to perform multiple tasks efficiently, be computer literate and must be very knowledgeable of all claims processing rules and guidelines
Must have knowledge of CPT Codes and ICD10 Codes
Must have Knowledge on all lines of business Medicare, Medi-Cal, and Commercial
Familiar with regulatory agencies such as CMS, DMHC, DHCS (State of Cal)
Familiar with required laws pertaining to HIPPA Security & Privacy, Fraud Waste and Abuse
Knowledge of health plans, medical groups, and managed care operations and related functions and regulations
Relevant bachelor's degree: or equivalent work experience required
Ability to work in a fast-paced environment
Knowledge of software applications such as EZCAP
Must be able to efficiently prioritize multiple high priority tasks
Must maintain strict confidentiality of all patient information and IPA business
Benefits
Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
Career Development: Tuition reimbursement to support your education and growth.
Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!
Company
Advanced Medical Management, Inc.
Advanced Medical Management, Inc.
51-200 employees
H1B Sponsorship
Advanced Medical Management, Inc. has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (2)
2020 (1)
Funding
Current Stage
Growth StageRecent News
Company data provided by crunchbase