Claims Quality Auditor
Quality Assurance Auditor
POSITION SUMMARY
Working independently and in groups the Quality Assurance Auditor will be responsible for the completion of multiple audit tasks including but not limited to auditing provider and eligibility matched claims, paper batch, and data captured claims, along with compiling and reporting results and trends accurately. The QA Auditor is also responsible for ensuring compliance with established internal control procedures by examining records, reports, operating practices, and documentation.
ESSENTIAL FUNCTIONS
Log and track data to be audited
Communicate and coordinate with other departments involved in the audit process
Assist with current audit programs in place as well as identify ways to improve audit results
Track and report audit trends and communicate training requirements to Management based on audit results
Monitor and track audit progress to ensure all audit task are complete by the determined deadline
Audit data for accuracy as well as workflow compliance
Other duties as assigned
EDUCATION
Bachelor's degree or equivalent work experience required.
EXPERIENCE & SKILLS
Minimum 5 years of comprehensive experience with auditing medical, dental, and vision claims required.
Proficient in Microsoft Word and Microsoft Excel
Strong written and verbal communication skills required
Ability to effectively manage assigned workload, including multiple task and competing priorities
COMPETENCIES
Job Knowledge
Time Management
Accountability
Communication
Initiative
Customer Focus
PHYSICAL DEMANDS
This is an office environment requiring extended sitting and computer work
WORK ENVIRONMENT
Remote
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Apply Now
POSITION SUMMARY
Working independently and in groups the Quality Assurance Auditor will be responsible for the completion of multiple audit tasks including but not limited to auditing provider and eligibility matched claims, paper batch, and data captured claims, along with compiling and reporting results and trends accurately. The QA Auditor is also responsible for ensuring compliance with established internal control procedures by examining records, reports, operating practices, and documentation.
ESSENTIAL FUNCTIONS
Log and track data to be audited
Communicate and coordinate with other departments involved in the audit process
Assist with current audit programs in place as well as identify ways to improve audit results
Track and report audit trends and communicate training requirements to Management based on audit results
Monitor and track audit progress to ensure all audit task are complete by the determined deadline
Audit data for accuracy as well as workflow compliance
Other duties as assigned
EDUCATION
Bachelor's degree or equivalent work experience required.
EXPERIENCE & SKILLS
Minimum 5 years of comprehensive experience with auditing medical, dental, and vision claims required.
Proficient in Microsoft Word and Microsoft Excel
Strong written and verbal communication skills required
Ability to effectively manage assigned workload, including multiple task and competing priorities
COMPETENCIES
Job Knowledge
Time Management
Accountability
Communication
Initiative
Customer Focus
PHYSICAL DEMANDS
This is an office environment requiring extended sitting and computer work
WORK ENVIRONMENT
Remote
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Apply Now