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POSITION:&nbsp; Compliance and Quality Nurse AuditorREPORTS TO:&nbsp; Chief Compliance and Privacy Officer<h4>POSITIONDESCRIPTION:</h4>The Compliance and Quality Nurse Auditor will be responsible for ensuring the appropriateness, effectiveness, and compliance of home healthcare services.&nbsp;The role involves reviewing member records, conducting audits, and analyzing data to identify areas for identifying any over/under utilization patterns, and identifying improvement in auditing, compliance, and utilization management processes and adherence to NCQA UM.&nbsp;The goal is to optimize resource use, ensure member safety, and comply with NCQA, health plan and all Federal/State regulatory requirements. Primarydutiesinclude,butarenotlimitedto:<h4>ESSENTIALFUNCTIONS:</h4><ul><li>Conduct auditing of utilization reviews to assess the appropriateness, medical necessity, and efficiency of home healthcare services provided to members. Processes and assists in monitoring and oversight through audits and education for health plan member’s prior, post and re-authorization requests as outlined by company , regulatory and health policy.</li><li>Analyze utilization data and identify trends, patterns, and opportunities for improvement in healthcare service delivery.</li><li>Collaborate with internal team members, healthcare providers, insurance companies, and other stakeholders to gather necessary information and ensure compliance with regulatory guidelines.</li><li>Enforce and create quality improvement initiatives to enhance the efficiency and effectiveness of home healthcare services.</li><li>Review and interpret healthcare policies, regulations, and guidelines to ensure compliance and adherence to industry standards.</li><li>Maintain accurate and detailed documentation of auditing utilization review activities, findings, and recommendations.</li><li>Provide feedback and education as applicable to clinicians regarding best practices and strategies for complying with regulatory and health plan rules.</li><li>Stay updated with changes in healthcare regulations and industry standards, ensuring that all utilization review activities are in compliance.</li><li>Ensure utilization management program policies and procedures meet all federal and state guidelines as well as NCQA/URAC accreditation standards as well as be the department resource to ensure understanding of timeliness measures and other regulatory and accreditation UM standards.</li><li>Coordinate the development of reporting required by state and federal agencies and consulting with the configuration team regarding opportunities to enhance the efficiency and quality for users of the information system to support Compliance and UM activities.</li><li>Coordinate,participate (as required)andcollaboratewith the Compliance teamin the preparation and execution of state and federal agency audits, including health plan and CMS audits. This may include preparation of files, leading mock audits, regular data universe audits and process audits.</li><li>Identifyareasandrootcausesofoperationalissuesthatneedcorrectiveactionandcollaborate with the business team(s) on the remediation activities.</li><li>Ensure entry of data requirements into utilization management software platform is consistent, accurate, and appropriate per workflow requirements and documentation standards.</li><li>Facilitates communication and provides ongoing customer service support to payer plan case managers, members and provider staff and team members.</li><li>Periodic after-hours and weekend rotation and availability to address after hour health plan grievance and appeals process related to home health services and management of care.</li><li>Reviews documentation and provides feedback to clinicians regarding CMS Chapter 7, 16 and Milliman Care Guidelines to ensure accurate assessment and review data, medical records reflect compliance withmedicalnecessity,homeboundstatus,visitutilizationsupportedbyindividualpatientassessment/ documentation support and transition (discharge) planning.</li><li>IdentifiesproblemsrelatedtothequalityofpatientcareandrefersthemtotheQualityAssurance Committee/QPUCS.</li><li>AssiststheComplianceandUtilizationReviewCommittee/QPUCintheassessmentandresolutionof utilization review issues.</li><li>Otheractivitiesasassigned.</li></ul><h4>OFFICELOCATION:</h4><ul><li>Office located 7600 North 16th Street, Suite 140 Phoenix, AZ 85020</li><li>REMOTE&nbsp;</li></ul>QUALIFICATIONS<ul><li>An active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN), license to practice as a health professional in a state (including Arizona) or territory of the United States is required for this role. Is a graduate of an accredited school/program of registered nursing or practical/vocational nursing.</li><li>Has at least five years of general nursing experience in home health, medical/surgical, geriatrics, or critical care, and at least three years of utilization review/management, or case management with experience in home health.</li><li>Is detail oriented and displays organizational skills as well as professional oral and written communication skills.</li><li>Is self-directed, flexible, cooperative, and exhibits the ability to work with minimal supervision.</li><li>Working knowledge of home care regulatory, Federal and State requirements such as Medicare, Medicaid, and Commercial guidelines.</li><li>Experience translating complex regulations and standards into policies and procedures, job aides and teaching materials as applicable.</li><li>Must be self-motivated, able to take initiative, and ability to thrive and drive results in a collaborative team based environment.</li><li>Must possess strong organizational and prioritization skills and competence and capacity to handle multiple initiatives while managing conflicting priorities</li><li>&nbsp;Experience with problem management, change control and how to influence change without direct control within a decentralized business unit culture.</li><li>Ability to develop strong cross-functional and collaborative relationship with internal and external partners, including the ability to work with a wide variety of people and personalities.</li><li>Excellent organizational and time management skills, with the ability to prioritize and manage multiple tasks and deadlines.</li><li>Proficient in Microsoft Office Suite (Word, Excel, PowerPoint) and other relevant software applications.</li><li>Periodic after-hours and weekend rotation and availability to address after hour health plan grievance/appeals process related to home health services and management of care.</li></ul><h4>KNOWLEDGEAND EXPERIENCE:</h4>Requires knowledge in the areas of home health community-based services; utilization/case managementexperience.Musthaveaworkingknowledgeofhomecare,managedcare,medical/nursing staff procedures, and community resources. NCQA and URAC knowledge is required.ComputerskillssuchasMSOfficeproducts-Outlook,Excel,Word,Adobeandtheabilitytoworkwithin multiple electronic medical management systems.Three(3) years ofutilizationmanagement/quality improvementexperience required.Advancedknowledgeandunderstandingofbasicutilizationmanagementandqualityimprovement concepts required.AdvancedknowledgeofCMS,NCQA,URACand/orStateutilizationmanagementstatutesand standards required.<h4>CONTINUINGEDUCATION REQUIREMENTS:</h4>Company personnelareexpectedtoparticipateinappropriatecontinuingeducationas may berequested and/or required by their immediate supervisor. In addition, company personnel are expected to accept personal responsibility for other educational activities to enhance job related skills and abilities. All company personnel must attend mandatory educational programs. tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

tango

Compliance and Quality Nurse Auditor

tango is a leader in the home care health management industry and is preparing for significant growth! We are hiring a Business Intelligence Developer to join our team! The Business Intelligence Developer will work with many diverse types and sources of healthcare data, including referral, authorization and claims data. This person will have a general understanding of healthcare claims data and a working knowledge of coding (ICD, HCPCS, CPT® etc.). This individual will also have a strong analytic background and experience working with healthcare data and strong experience with SQL. This person will develop and manage SQL databases for reporting and analytics, as well as manage data transfer and data load processes and reporting.Responsibilities·Designs and writes code for ETL data solutions.·Plans and executes data warehouse implementations following system requirements and anticipated usage.·Performs data extraction, ensures data accuracy, troubleshoots, and resolves bugs during data warehouse operations.·Analyzes business intelligence data and designs and generates reports.·Lead as SQL database subject matter expert·Support business team in requirements gathering·Work with data integration team to define and load data sources from multiple data warehouse systems·Function as the primary liaison between the business team and IT to ensure timely delivery of world-class products·Maintain SQL databases to ensure optimal Power BI report performance·Build Power BI reports and dashboards based on business requirements as needed·Build out UAT scripts and run test sessions to support “ready to go” state for data management and reporting·Maintain thorough documentation of internal processes/procedures and individual projectsEducation<ul><li>Bachelor’s Degree Required or equivalent experience </li></ul>Experience<ul><li>5-10yearsofSQLdatabasedevelopmentexperience</li><li>&nbsp;PowerBIexperiencepreferred</li><li>Healthcareexperiencepreferred</li><li>HomeHealthexperienceisaplus</li></ul>Qualifications<ul><li>Project management proficiency – proven ability to successfully lead complex projects (5+ Years)</li><li>Querying SQL Server, Teradata, Greenplum, or Hadoop (1+ Year)</li><li>Knowledge of database management, including diagnostics and resolution of database errors (1+ Year)</li><li>Working knowledge of Power BI (1+ Year)</li></ul>Job Type<ul><li>Full -time</li><li>Remote - United States</li></ul>tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

Developer, Business Intelligence

**No visa sponsorship available for this role**We are seeking a driven and self-directed Data Engineer with a deep understanding of healthcare data to join our growing development team. This role is ideal for someone who thrives on solving complex problems, takes initiative, and enjoys building data infrastructure from the ground up.The successful candidate will have a strong background in designing and optimizing data pipelines, working across cross-functional teams, and enabling data-driven decision-making through scalable, secure architecture. You will collaborate closely with software developers, product managers, and analytics teams to ensure consistent, high-quality data delivery across the organization. The right candidate will be excited by the prospect of optimizing or even re-designing our company’s data architecture to support our next generation of products and data initiatives.Responsibilities for Data Engineer<ul><li>Create and maintain optimal data pipeline architecture, define, and maintain ETL/ELT using moderns tools and techniques.</li><li>Develop scalable and secure solutions for data ingestion, transformation, and storage across structured and unstructured sources</li><li>Optimize existing systems and processes, including automation of manual workflows, infrastructure redesign, and performance tuning.</li><li>Strong proficiency in Microsoft Fabric tools (data pipelines, OneLake, Data Warehouses, Azure Data Lake, etc).</li><li>Hands-on experience with Power BI, including DAX, Power Query(M) and Power BI Service.</li><li>Build the infrastructure required for optimal extraction, transformation, and loading of data from a wide variety of data sources using SQL and Azure cloud technologies.</li><li>Build analytics tools that utilize the data pipeline to provide actionable insights into customer acquisition, operational efficiency, and other key business performance metrics.</li><li>Work with stakeholders including the Executive, Product, Data and Design teams to assist with data-related technical issues and support their data infrastructure needs</li><li>Design and implement data curation, metadata management, and de-identification solutions to meet healthcare compliance analytics needs.</li><li>Create tools for analytics and assist team members in building and optimizing our product into an innovative industry leader.</li><li>Work with data and analytics experts to strive for greater functionality in our data systems.</li><li>Support data curation, metadata management, de-identification, and scalability initiatives to enhance business insights and outcomes.</li><li>Maintain a strong focus on data privacy, environment segregation, and access control.</li></ul>Qualifications for Data Engineer<ul><li>Significant experience in the U.S healthcare domain, with deep knowledge of payer and provider data models.</li><li>Capable of owing initiatives from concept to implementation with minimal oversight.</li><li>Advanced working SQL knowledge and experience working with relational databases, query authoring (SQL) as well as working familiarity with a variety of databases.</li><li>Experience building and optimizing data pipelines, architectures, and data sets.</li><li>Experience with programing to develop and code ETL.</li><li>Experience performing root cause analysis on internal and external data and processes to answer specific business questions and identify opportunities for improvement.</li><li>Strong analytic skills related to working with structured/unstructured datasets.</li><li>Build processes supporting data transformation, data structures, metadata, dependency and workload management.</li><li>We are looking for a candidate with 3+ years of experience in a Data Engineer role, who has attained a bachelor’s degree in Computer Science, Statistics, Informatics, Information Systems or another quantitative field. </li><li>They should also have experience using the following software/tools:<ul><li><ul><li>Experience with Database Administration/Maintenance</li><li>Experience with big data tools, distributed SQL: Azure Data Factory/Synapse.</li><li>Experience with SQL Server.</li><li>Experience with Analytics Tools: Power BI</li><li>Experience with Microsoft Azure cloud services</li><li>Familiarity with data governance tools like Microsoft Purview</li><li>Strong understanding of data security, access control, and compliance best practices</li><li>Good customer engagement and collaboration</li></ul></li></ul></li></ul>Job Type:&nbsp;Full-timeLocation: Remote, USAtango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.**No visa sponsorship available for this role**

Healthcare Data Engineer

Tango a leading Post-Acute Management Services company that manages home health benefits for major insurance plans, is seeking a detail-oriented and self-motivated Provider Support Specialist. This individual will work under the Network Operations Manager to assist in provider onboarding, streamline workflows, and enhance the Pronet Connect portal. The Provider Support Specialist will focus primarily on our internal portal and issue resolutions for our providers. The Provider Support Specialist will review, triage, and resolve tickets and chats in real time submitted by the tango Network providers. In addition, the Network Operations Specialist will help to ensure the success of current and new providers within the tango network, assist in drafting formal provider communications, assist in managing provider relations email, facilitate provider surveys, and work with senior management to optimize workflows from credentialing approval to provider training. A process-driven mindset is essential for this role. This is an entry level administrative position that will build experience and skills around supporting our providers and enhancing provider engagement.RESPONSIBILITIES Essential functions of the job are listed below. &nbsp;Other responsibilities may also be assigned. Please note that the essential functions may vary depending on department size, organizational structure and/or geographic location. &nbsp;Reasonable accommodations may be made to allow differently-abled individuals to perform the essential functions of the job.Primary Responsibilities<ul><li><ul><li>Address, resolve, and/or triage provider tickets via our provider portal ticketing system.</li><li>Handle chat interactions to provide real-time support and issue resolution to providers.</li><li>Collaborate intra-departmentally and inter-departmentally to ensure prompt resolution of provider issues.</li><li>Assist in the end-to-end provider onboarding process, including training, webinars, and strategic data analysis.</li><li>Communicate resolution status and updates to providers and internally in a timely manner.</li><li>Provide assistance in guidance and training internally and externally on the use of our provider portal and related tools.</li><li>Assist in coordinating formal provider communications to tango's Network, ensuring effective messaging for both payers and providers.</li><li>Assist in managing responses to provider inquiries promptly and effectively via the Provider Relations email box.</li><li>Communicate any provider-related issues to the direct Supervisor and Network team.</li><li>Identify and communicate process improvement opportunities, collaborating with cross-departmental teams and the direct Supervisor.</li><li>Maintain strict privacy and confidentiality standards in all interactions and tasks.</li><li>Perform various support duties for Network Operations as assigned by the direct Supervisor and required by the Network team.</li><li>Respond promptly to voicemail, email, and colleague requests.</li><li>Develop and document job aides, processes, and policies for internal platform configuration.</li></ul></li></ul>Additional Responsibilities<ul><li><ul><li>Additional duties may involve support in training new team members and collaborating with cross-departmental teams to ensure a smooth Provider Onboarding process.&nbsp;</li></ul></li></ul>MINIMUM QUALIFICATIONS The following are the minimum qualifications that an individual needs in order to successfully perform the duties and responsibilities of this position. &nbsp;Please note that the minimum qualifications may vary based upon the department size and/or geographic location.Knowledge/ Experience<ul><li><ul><li>Equivalent to a high school diploma.</li><li>Proficient use of Microsoft Office and Adobe applications (Word, Excel, Powerpoint, etc). </li><li>Consistent and reliable WiFi.</li><li>Experience in healthcare (home health or credentialing a plus), or similar role, preferred but not required.</li></ul></li></ul>Skills / Abilities Pertinent to This Position<ul><li><ul><li>Project Management: a. &nbsp; &nbsp;Manage and coordinate end-to-end processes including onboarding, training, and communication. b. &nbsp; &nbsp;Ensure timely completion of tasks with attention to detail.</li><li>Communication Skills: a. &nbsp; &nbsp;Exhibit strong written and verbal communication skills. b. &nbsp; &nbsp;Draft formal communications, respond to inquiries promptly and professionally, and convey information clearly to providers, stakeholders, and internal teams.</li><li>Analytical Skills: a. &nbsp; &nbsp;Analyze data, survey results, and key trends to identify insights and drive process improvements. b. &nbsp; &nbsp;Use data to make informed decisions and enhance internal procedures.</li><li>Attention to Detail: a. &nbsp; &nbsp;Ensure accuracy and completeness in managing provider data, documentation, and communication materials. b. &nbsp; &nbsp;Pay attention to detail in troubleshooting issues and testing new features in the Provider Portal.</li><li>Customer Service Orientation: a. &nbsp; &nbsp;Deliver excellent customer service by responding to provider inquiries and managing relationships. b. &nbsp; &nbsp;Ensure a positive experience for the network by empathizing, problem-solving, and providing effective solutions.</li><li>Collaboration: a. &nbsp; &nbsp;Collaborate effectively with cross-functional teams including the direct supervisor, network team, and other departments. b. &nbsp; &nbsp;Identify process improvement opportunities and implement changes, demonstrating strong interpersonal skills, flexibility, and teamwork.</li><li>Confidentiality: a. &nbsp; &nbsp;Maintain privacy and confidentiality when handling sensitive provider information. b. &nbsp; &nbsp;Ensure compliance with data protection regulations and ethical standards.</li><li>Organizational Skills: a. &nbsp; &nbsp;Manage multiple tasks, prioritize responsibilities, and meet deadlines efficiently. b. &nbsp; &nbsp;Handle email and voicemail correspondence promptly and effectively.</li><li>Technical Aptitude: a. &nbsp; &nbsp;Demonstrate proficiency in using and troubleshooting software applications, particularly the Provider Portal and in-house automated systems. b. &nbsp; &nbsp;Develop and document job aids, processes, and policies related to system configuration.</li><li>Adaptability: a. &nbsp; &nbsp;Adapt to changes in processes, technologies, and responsibilities in a dynamic work environment. b. &nbsp; &nbsp;Embrace opportunities for learning new skills and professional growth.</li></ul></li></ul>tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

Provider Support Specialist

Position: Qualification Coordinator IIDepartment: Referral ManagementReports to: Referral Management SupervisorPosition Description:The Qualification Coordinator II is responsible for accurately processing all assigned referrals. The Qualification Coordinator II acts as a liaison to facilitate communication between referral sources, patients, and the health care agencies. The Qualification Coordinator II maintains accurate records in compliance with applicable laws and regulations and the policies of tango.Office Location:<ul><li>Office located at 7600 North 16th Street, Suite 140 Phoenix, AZ 85020 (Remote)</li></ul>Responsibilities and Duties:Responsibilities of the Qualification Coordinator II include, but are not limited to the following:&nbsp;<ul><li>Receive referrals and enter all applicable information regarding the patient referrals into referral management system including but not limited to: patient demographics, contact information, disciplines requested and all necessary medical information to affirm appropriate patient care&nbsp;</li></ul><ul><li>Ensure all attached documents are HIPAA compliant for each referral processed.&nbsp;&nbsp;</li></ul><ul><li>Identify and process expedited requests immediately and communicate the priority status to all appropriate internal teams.&nbsp;</li></ul><ul><li>Verify insurance eligibility for each patient through software automation, running insurance manually through payor websites when needed.&nbsp;&nbsp;</li></ul><ul><li>Contact appropriate parties (patient and/or referral source) of prior authorization decisions; including but not limited to approvals, requests for more information or not able to process due to insurance.&nbsp;</li></ul><ul><li>Call agencies to coordinate continuance of patient services.&nbsp;</li></ul><ul><li>Ensure service requests include all required documentation and that services approved are appropriate based on documentation provided.&nbsp;</li></ul><ul><li>Contact patients and referral sources to obtain any additional information needed and inform of referral processing outcomes.&nbsp;</li></ul><ul><li>Identify and escalate referrals for medical review to the clinical team and follow through on the resolution of each referral.&nbsp;</li></ul><ul><li>Upon approval of referrals, apply the appropriate visits/disciplines to the patient referral per the patient’s demographic area.&nbsp;</li></ul><ul><li>Accurately staff referrals with contracted Home Health Agencies.&nbsp;&nbsp;</li></ul><ul><li>Properly document patient records with the use of notes within the Tempo system and maintain required logs.&nbsp;&nbsp;</li></ul><ul><li>Accurately follow up on patient referrals as needed.&nbsp;&nbsp;</li></ul><ul><li>Adhere to all company policies and procedures&nbsp;</li></ul><ul><li>Adhere to performance expectations&nbsp;&nbsp;</li></ul>Qualifications:<ul><li>Must be at least 18 years of age.&nbsp;</li></ul><ul><li>High School Diploma or GED, some college&nbsp;</li></ul><ul><li>Medical Assistant or Certified Nursing Assistant with at least 2 years of experience working in a Medical Facility.&nbsp;&nbsp;</li></ul><ul><li>Home care/healthcare background is a plus but not required.&nbsp;</li></ul><ul><li>Has extensive knowledge and experience including but not limited to: Microsoft Word, Microsoft Excel, Adobe PDF, and ability to navigate computer systems efficiently.&nbsp;</li></ul><ul><li>Typing speeds &gt;60 WPM with &gt;95% Accuracy.&nbsp;</li></ul><ul><li>Reading speeds &gt;250 WPM with &gt;90% Comprehension.&nbsp;</li></ul><ul><li>Must be flexible and willing to work weekends and Holidays.&nbsp;</li></ul><ul><li>Detail oriented and displays good organizational skills.&nbsp;&nbsp;</li></ul><ul><li>Must be able to sit for long periods in front of computer.&nbsp;</li></ul><ul><li>Must have reliable internet service or willing to commute to the office if local.&nbsp;&nbsp;</li></ul>Proven Personal Attributes:<ul><li>Manage and prioritize multiple tasks effectively and efficiently while working home health referrals.&nbsp;&nbsp;</li></ul><ul><li>Able to apply critical thinking skills to review referrals and determine if they meet the medical necessity criteria.&nbsp;</li></ul><ul><li>Demonstrate empathy and compassion when communicating with patients regarding authorization decisions.&nbsp;</li></ul><ul><li>Proactive in identifying and resolving any issues or challenges that may arise during the referral management process.&nbsp;&nbsp;</li></ul><ul><li>Self-directed, flexible, cooperative, and exhibits the ability to work with minimal supervision.&nbsp;</li></ul><ul><li>Capable of following an issue through to its conclusion.&nbsp;</li></ul><ul><li>Maintain a growth mindset on improving knowledge in referral management practices.&nbsp;</li></ul><ul><li>Able to remain calm under pressure and manage stressful situations.&nbsp;</li></ul><ul><li>Provide excellent and professional customer service skills with a positive, patient, and friendly attitude.&nbsp;</li></ul><ul><li>Able to establish highly productive and detailed organizational skills/habits.&nbsp;</li></ul><ul><li>Possess strong, professional written and oral communication skills for in-person, telephonic, and electronic use.&nbsp;</li></ul>tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

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