Location: all cities,AK, USA
Perform routine random/target audits of operational processes (e.g., call centers, enrollment/terminations, invoicing/dunning, member/provider notifications, workforce management, sales/retention, etc.) across multiple lines of business and productsConfirm employee adherence to company, state and federal policies and procedures including compliance and regulatory guidelinesPrepare written audit reports on findings and communicates audit findings with appropriate leadershipIdentify quality, operational efficiency, and production goal defects to support the improvement of departmental performanceIdentify patterns, trends and variances related to audited performance and provide feedback to appropriate leadersMeet established time frames and rates of performance for both quality and quantity of workConduct compliance audits to ensure members and/or provider accounts are accurately and timely handled according to contracted and regulatory guidelinesProvide suggestions and recommendations on improving controls to gain efficiency and strengthening of performance and compliance measuresAssist in the development of departmental policies and proceduresReview the accuracy and efficiency of existing training materialsComply with HIPAA guidelines and maintain confidentiality of employee, member, provider, medical and departmental informationAdditional duties as assignedMinimumQualifications:Healthcare operations experience working in a Quality Assurance, contact center, member enrollment and billing, or provider data managementPrior working experience with Microsoft Office suite of applications including Excel (which includes formatting formulas, managing data, and filtering results), Word, PowerPoint, and OutlookExperience conducting analytical work and providing creative ideas for problem solvingWork experience requiring written and verbal communication that is clear, concise, grammatically correct, and professionalHigh School Diploma or GED from an accredited institutionPreferred Qualifications:Experience handling Personal Health Information (PHI) in a professional mannerExperience in an Auditing capacity where you have conducted root cause analysisAbility and willingness to handle increasing workload and responsibilityWillingness and ability to learn and evaluate new information, both technical and proceduralKnowledge of at least two or more lines of business such as NY Medicare, Medicaid, Family Health Plus, or Child Health Plus, etc.Associate degree or higherCompliance & Regulatory Responsibilities: See AboveLicense/Certification: N/AWE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.