Operations Quality Auditor
About The Position
Under the direct supervision of the Supervisor, Manager, and/or Director of Operations Quality Auditing, the Operations Quality Auditor is responsible for the timely and accurate review of various tasks performed by Operations (including, but not limited to, Claims). AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Requirements
- High School/GED required.
- Minimum 3 years’ claims experience in a Medicaid environment.
- Claims processing knowledge required, preferably with the Facets system.
- Working knowledge of Microsoft Office applications.
- Must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required.
Responsibilities
- Identifies system and/or operational issues hindering the attainment of quality performance standards as defined by AMFC policy and associated business rules.
- Provides issue identification, problem analysis, and strategies for resolution and/or implementation to Management.
- Accurately documents audit findings in the appropriate quality tool.
Benefits
- Flexible work solutions including remote options, hybrid work schedules
- Competitive pay
- Paid time off including holidays and volunteer events
- Health insurance coverage for you and your dependents on Day 1
- 401(k)
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
