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Quality Assurance Auditor

Remote:

Full Remote

Contract:

Full time

Salary:

10 - 10K yearly

Experience:

Senior (5-10 years)

Work from:

United States

Offer summary

Qualifications:

Bachelor's degree or equivalent experience, Minimum 5 years of auditing experience, Proficient in Microsoft Word and Excel, Familiarity with plan coding, Strong written and verbal communication skills.

Key responsabilities:

Complete audits for medical, dental, and vision claims
Audit outgoing correspondence from multiple teams
Communicate and coordinate with involved departments
Track and report audit trends and progress
Assist with current audit programs and improvements

Allied Benefit Systems, LLC Unicorn https://www.alliedbenefit.com/

501 - 1000 Employees

See more Allied Benefit Systems, LLC offers

Job description

Your missions

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 the builds of plan coders as needed for all new and existing revisions, along with compiling and reporting results and trends accurately. The QA Auditor is also responsible for auditing outgoing correspondence from the Medical Review, Appeals, and Refund teams, as well as complete audit of claim adjustments by the Rapid Response team. The QA Auditor will interpret the benefits in the plan documents to determine how benefits are payable and tracked/reported in the QicLink system.

Essential Functions

Log and track data to be audited
Audit outgoing correspondence from the Medical Review, Appeals, and Refund teams
Conduct complete audit of claim adjustments by the Rapid Response team
Communicate and coordinate with other departments involved in the audit process
Audit new and existing plans built by plan coders for all new and existing revisions
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
Some familiarity with plan coding
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.