Location: Buffalo,NY, USA
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.
Overview
The Quality Assurance Auditor is responsible for performing monitoring, oversight, and quality assurance reviews/audits of assigned operational areas ensuring the quality and accuracy of the systems and processes that support the organization's operation. They will track issues identified during the quality assurance process to ensure resolution. The Quality Assurance Auditor will analyze, document, and report on results to business stakeholders and company leads. They will collaborate within the Quality Assurance team and other cross functional teams to remediate auditing findings, to develop and improve testing and audit strategies, techniques, activities, policies and procedures. Occasional evenings, weekends and holidays are a requirement of the position.
Qualifications
* High School diploma or GED required; Associate's degree preferred.
* Three (3) years of experience in Quality Assurance/Quality Control, pharmaceutical or managed care environment required.
* Experience with pharmacy on-line claims processing systems preferred.
* Strong analytical, problem solving, time management and organizational skills.
* Detail oriented, while maintaining an awareness of overall goals.
* Advanced PC and Windows skills. Experience with Microsoft Office applications, AS400 query and/or other query tools; and demonstrated ability to learn new software applications.
* Experience in report production, and the ability to maximize use of system capabilities to lead the organization in outcome improvement.
* Excellent interpersonal, written and verbal communication skills.
* Proven examples of displaying PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.
Essential Accountabilities
Quality Assurance and Auditing
* Perform quality assurance and auditing processes to ensure accurate servicing operations, benefit information and functionality for adjudication within the pharmacy system, external communications, documentation as required by regulatory bodies and other operations and processes; including but not limited to:
* Development, implementation and maintenance of manual and automated test scripts utilizing testing tools.
* Development, implementation and maintenance of test cases, data, files and strategies.
* Participate in all aspects of testing including functional, regression, performance and system testing.
* Log and manage defect status and resolution grid.
* Development, implementation and maintenance of policies, procedures, manuals, and other necessary documentation of the QA/QC process.
* Conduct internal audits to measure and ensure adherence to claims processing standards.
* Support cross-functional projects, represent the quality assurance team at meetings, review requirements, develop test approach, and provide feedback.
* Work on issues of moderate to complex scope where analysis of data is required.
Quality Control
* This includes but is not limited to:
* Development of effective relationships that support appropriate feedback and development.
* Report quality assurance and audit results to management and leadership teams.
* Identify, monitor and communicate trends in inaccuracies and work with PBD system teams to resolve them.
* Perform ad hoc queries in audit database in support of decision making.
* Perform integration testing, and track, document and verify and work with subject matter experts to resolve defects.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $23 - $26 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.