Vacancy expired!
Job Description
Quality Auditor - RemoteDuties: Responsible for reviewing and evaluating the quality and effectiveness of the department policies and procedures, processes, and system updates such as member eligibility, provider setup, benefit/contract/edit configuration, and/or code/rate updates. Partner with the department managers on audit findings to ensure identified errors are promptly and appropriately corrected, as well as identified performance and/or training gaps are addressed. Track and report quality metrics for the department. Serve as the department's point of contact for audit inquiries. Collaborate with the department managers for eligibility, provider setup, and medical policy/configuration to develop an audit program to review and evaluate the quality, accuracy, and timeliness of system updates. Clearly and concisely report audit findings on a frequent basis to the department managers to assist with identifying performance and training gaps for their respective team. Partner with the department managers to ensure errors identified are corrected promptly and appropriately.Skills: Knowledge of Texas Managed Care Medicaid. Knowledge of member eligibility, provider/benefit/contract configuration, and claims processing. Strong technical skills, including proficiency in standard business software (e.g., Microsoft Office Suite) and health plan payer systems/applications. Ability to apply critical thinking skills, as well as conduct thorough research and analysis to identify root cause and resolve problems/issues. Ability to effectively communicate in a clear and concise manner both verbally and in writing. Detail oriented and organized with the ability to manage multiple assignments/projects simultaneously. QUALIFICATIONS The formal education and experience required for completely satisfactory performance in this job are as follows: Education Req Pref Education Level Education Details X H.S. Diploma or GED X Bachelor's Degree Healthcare Administration, Business Administration, Computer Science, or related field. Licenses and Certifications Req Pref Enter Licenses/Certifications Licensing Authority Experience Req PrefEducation: Required- H.S. Diploma or GEDRequired- 2 years Medicaid Managed Care And 4 years Health plan operations And 4 years Health plan payer systems/applications#LI-DNPVacancy expired!