Location: Philadelphia,PA, USA
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
Job Summary
* Ensure timely and complete execution of external audits in accordance with established audit practices and regulations with a focus on testing, operational quality reviews, and material preparation for management review.
* Perform operational audits and provide results
* Serve as point of contact for external and internal stakeholders.
* Review audit responses for accuracy and completeness and modify as needed for an internal or external audience.
* Prepare audit supporting documentation.
* Monitor the resolution of systemic issues.
* Perform root cause analysis of issue trends identified through audits.
* Perform all other duties as assigned.
Qualifications
* BA/BS in Business Administration, or healthcare related discipline, or equivalent knowledge acquired by on-the-job training and experience.
* Three (3) or more years of healthcare claims audit or progressively more responsible experience in Customer Service, Enrollment, Claims, Provider Services, Medicare, or Quality review related activities.
* Preferred but not required working knowledge/understanding of audit procedures, requirements, and practices related to internal and external audits.
* Working knowledge of healthcare operations and general understanding of claim adjudication, provider pricing/contracting for eligibility, and healthcare benefit products.
* General working knowledge of operating systems related to claims, customer service, and enrollment.
* General understanding and knowledge of benefits coding and pharmacy services.
* Preferred general familiarity and acquire a working knowledge of BCBSA guidelines for Member Touchpoint Measures (MTM) and BCBSA Licensee Desk Level Audit (LDLA) is a plus.
* Preferred but not required working knowledge of federal regulations regarding Federal Employee Program (FEP) is a plus.
* Excellent organizational, presentation, and communication skills.
* Strong ability to collaborate and communicate with team members and business partners.
Independence has implemented a Hybrid model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the Hybrid model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.