Operations - Spec, Quality Assurance III
Operations - Spec, Quality Assurance III
PURPOSE:
The Quality Assurance Specialist III is an advanced-level auditor position performing in-depth system and procedural audits. This role conducts regular reviews and audits of internal controls within each functional area for strengths and weaknesses ensuring special focus to the specific risk areas. The incumbent is considered a Subject Matter Expert (SME) in their audit field and provides a comprehensive analysis of transaction, systems and procedures.
ESSENTIAL FUNCTIONS:
50% Audits assigned function (service, claims, enrollment) for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents and reports transaction errors utilizing departmental quality monitoring templates in a timely manner to ensure prompt resolution
20% Assists in development of special department projects and participates in department and divisional projects
20% Conducts structured coaching and feedback sessions. Provides suggestions and creates improvement plans for areas of deficiency within the group or for an individual
10% Participates in the creation and implementation of new methods, processes and/or products
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: High School Diploma
Education Details: or GED
Experience: 5 years Auditing, Quality Assurance, Operations, Training, Project Management or comparable work experience
2 years experience as Quality Assurance Specialist II
Preferred Qualifications
Knowledge, Skills and Abilities (KSAs)
Knowledge of quality assurance and production technologies., Expert
Proficient in Microsoft Office programs., Proficient
Extensive of industry standards, quality control techniques and procedures., Advanced
Excellent communication skills both written and verbal., Advanced
Extensive analytical and problem solving skills, Advanced
Strong interpersonal skills, Advanced
Excellent research and organizational skills, Advanced
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. Additional Skills: Coding certification (CPC or COC, CPMA et., Claims and insurance experience. Medical records auditing.
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
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PURPOSE:
The Quality Assurance Specialist III is an advanced-level auditor position performing in-depth system and procedural audits. This role conducts regular reviews and audits of internal controls within each functional area for strengths and weaknesses ensuring special focus to the specific risk areas. The incumbent is considered a Subject Matter Expert (SME) in their audit field and provides a comprehensive analysis of transaction, systems and procedures.
ESSENTIAL FUNCTIONS:
50% Audits assigned function (service, claims, enrollment) for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents and reports transaction errors utilizing departmental quality monitoring templates in a timely manner to ensure prompt resolution
20% Assists in development of special department projects and participates in department and divisional projects
20% Conducts structured coaching and feedback sessions. Provides suggestions and creates improvement plans for areas of deficiency within the group or for an individual
10% Participates in the creation and implementation of new methods, processes and/or products
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: High School Diploma
Education Details: or GED
Experience: 5 years Auditing, Quality Assurance, Operations, Training, Project Management or comparable work experience
2 years experience as Quality Assurance Specialist II
Preferred Qualifications
Knowledge, Skills and Abilities (KSAs)
Knowledge of quality assurance and production technologies., Expert
Proficient in Microsoft Office programs., Proficient
Extensive of industry standards, quality control techniques and procedures., Advanced
Excellent communication skills both written and verbal., Advanced
Extensive analytical and problem solving skills, Advanced
Strong interpersonal skills, Advanced
Excellent research and organizational skills, Advanced
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. Additional Skills: Coding certification (CPC or COC, CPMA et., Claims and insurance experience. Medical records auditing.
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Apply tot his job
Apply To this Job