Quality Auditor

Overview

Overview: UST HealthProof is looking for a Quality Auditor with health plan claims administration operations experience. This role will report to the Lead Auditor or Quality Audit Manager. The Opportunity: Perform audit of transactions processed by health plan administration associates for a specific customer. Be responsible for following the customer quality process and tools for audit and rebuttal process. Share QA results with individual associates, coordinate with operational Team Leads and managers to provide feedback to individuals, clearly identifying errors and opportunities of improvement. Collate, compile and reports both team and individual associates’ QA performance to management and individuals. Provide inputs to Training team and Team Leads for up-to-date written processing instruction/refresher training needs. Participate in semi-annual or annual auditor calibration activities. Maintain currency on CMS claims processing rules and guidelines for Medicare Advantage organizations and ACA Exchange and Off Exchange lines of business This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. What You Need: High School Diploma or GED required 3 years health plan claims auditing operations experience required Medicare claims auditing experience preferred Proficiency in using MS Suite, specifically Excel, PowerPoint and Outlook HealthRules Payor or Guiding Care exp preferred Ability to analyze contractual SLAs and KPIs Ability to effectively communicate and collaborate with a remote team Geographic Responsibility: Remote, US Type of Employment: Full-time, permanent Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in front of a computer using video technology. May require travel dependent on company needs. The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check. HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. #LI-Remote **The annual US base salary range for this position is $35,000 to $48,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.