Controls and QA Analyst

Southern Scripts•St. Louis, MO

8d•Onsite

About The Position

The Controls and QA Analyst is responsible for developing, monitoring, assessing, reviewing, and recommending changes to Liviniti’s quality and control procedures to ensure the highest quality standards in accordance with company policies. The Controls and QA Analyst works closely with the Claims Processing Director, the Claims Processing team, and the other members of the Controls and QA team. This role is heavily analytical and requires critical thinking skills.

Requirements

Problem Solving/Analysis
Critical Thinking
Time Management
Communication
Objectivity
Technical Expertise
Perform root cause analysis
Strong written and verbal communication skills
Exceptional listening and analytical skills
Proficient in Word, Excel, and PowerPoint for presentations and reports required
2 years of PBM experience in a Quality Analysis and Controls setting OR 3 years of PBM experience in Benefit Design execution or Implementation at a high level.

Nice To Haves

Bachelor’s degree
5 years QA experience in a PBM setting

Responsibilities

Providing quality assurance for internal processes and suggesting additional additions, when appropriate.
Understanding and defining the performance and quality standards expected of Claims Processing employees.
Evaluating quality standards from an objective point of view and ensuring the proper checks and balances are applied to all parts of the Claims Processing procedures.
Being fully trained in both the claims processor and other internal programs so an adequate knowledge base can be used when evaluating and following procedures.
Participating in the design of procedures of but not limited to reimbursement audits, group/plan design, in-house ticket, group/plan changes, SOC audits, and QA testing in internal program(s).
Remaining current on plan knowledge, policies, processes, procedures, and systems knowledge of Southern Scripts procedures.
Contributing to the continual evaluation, identification, and solving for inefficiencies of existing processes and procedures.
Creating a culture of continuous improvement.
Potentially providing training to internal teams on new procedures implementing updated quality controls.
Assisting with group/plan design, when necessary.
Managing tickets and accurately capturing/categorizing necessary trend information.
Supporting projects and initiatives which drive department strategy.
Sharing and communicating pertinent information with internal team members and internal partners.
Utilizing an in-depth understanding of technical principles, theories, and concepts in the field of quality to perform a thorough root cause and corrective action analysis.
Assisting with User Acceptance Testing for internal program development before enhancements are released.
Familiarity with external teams regarding test platform claims data/enhancement requests.
Analyzing and interpreting test claims for processing and adjudication results to ensure configuration accuracy.
Assisting other departments troubleshooting plan/benefit configuration related questions through claims testing.
Reporting findings and following through with resolution resulting from claims analysis.
Documenting results and following through resolution within departments tracking system.
Participating in a culture of continuous improvement, open door policy and internal support system.
Being an example for work ethic, growth, positivity, and external team communications.
Ensuring daily tasks performed by team meet quality and expectations of dept leaders.
Continuous involvement in claims analysis with QA team.
Abiding by all obligations under HIPAA related to Protected Health Information (PHI).
Reporting any discovered HIPAA violations to the Compliance Officer and/or Human Resources.
Attending, completing, and demonstrating competency in all required HIPAA Training offered by the company.