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Delegation Audit Assistant

Remote: 
Full Remote
Contract: 
Experience: 
Mid-level (2-5 years)
Work from: 

Offer summary

Qualifications:

High School Diploma or Equivalent required, Associate's degree in business or health care preferred, CPCS Certification required within 6 months, 3-5 years credentialing experience preferred, Intermediate level of excel skills required.

Key responsabilities:

  • Monitor and evaluate vendor performance according to CMS and NCQA
  • Support delegated credentialing audits and customer audits
  • Analyze problems and define action items for resolution
  • Identify opportunities for process improvement
  • Ensure successful delegation partnerships and compliance
Avesis, Incorporated logo
Avesis, Incorporated Insurance Scaleup https://www.avesis.com/
501 - 1000 Employees
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Job description

Join us for an exciting career with the leading provider of supplemental benefits!

Our Promise
Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Delegation Audit Assistant will monitor and evaluate the performance of national delegated vendors, local delegated vendors, and non-delegated vendors according to CMS, and NCQA, Federal and State requirements.

Essential Job Functions:

  • Support delegated credentialing audits in accordance with standard operational, regulatory, accreditation and compliance processes and procedures
  • Communicate post follow-up outcomes communication to mitigate operational risk of repeat corrective action plan
  • Support consistent and efficient processes to support the management of all delegated credentialing and internal audit activities
  • Support customer audits by preparing files and providing supplemental information as requested
  • Analyze and investigate, problem resolution; defining and recommending action items for the delegated group; evaluating outcomes and providing ongoing feedback to appropriate delegate and internal staff/committees; providing support at Regulatory and Accreditation surveys, as needed
  • Ensure successful delegation partnerships
  • Assist with file processing and quality assurance
  • Identify process improvement opportunities that decrease cost, improve quality, and increase efficiency within the department

Requirements:

  • High School Diploma or Equivalent required
  • Associate's degree in business or health care related field preferred
  • CPCS Certification required, may be obtained within 6 months of accepting position
  • 3-5 years credentialing experience, preferably in a managed care setting, preferred
  • Working knowledge of NCQA standards and payer credentialing standards
  • Knowledge of PSV, CAQH, OIG, NPDB
  • Intermediate level of excel skills required- should be able to use complex formulas and functions, Pivot tables and Pivot charts, V lookups, lookups to find information across multiple sheets
  • Strong data entry and clerical skills
  • Ability to research problems and find workable solutions
  • Ability to multi-task and work in a fast-paced environment
  • Excellent time management skills
  • As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 25 Mbps upload while hardwired and not on a VPN are sufficient.

We Offer

  • Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
  • Competitive compensation package.
  • Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
  • Life and disability insurance.
  • A great 401(k) with company match.
  • Tuition assistance, paid parental leave and backup family care.
  • Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
  • Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
  • Employee Resource Groups that advocate for inclusion and diversity in all that we do.
  • Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity

At Avēsis, We See You.  We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic.  At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients.  We focus on recruiting, training and retaining those individuals that share similar goals.  Come Dare to be Different at Avēsis, where We See You!

Required profile

Experience

Level of experience: Mid-level (2-5 years)
Industry :
Insurance
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Multitasking
  • Verbal Communication Skills
  • Clerical Works
  • Analytical Skills
  • Time Management

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