Performance Auditor Specialist

Elevance Health•Nashville, TN

2d•Hybrid

About The Position

The Performance Auditor Specialist provides technical and administrative support to Long-Term Services and Supports (LTSS) programs. The role supports timely initiation, coordination, and monitoring of services while contributing to operational excellence through reporting, quality assurance, data analysis, and process improvement. The specialist works with members, providers, care coordination teams, and internal stakeholders, and helps identify operational barriers, analyze trends, and recommend solutions that improve service delivery and member outcomes. The position includes retrieving and verifying system-generated reports, tracking claims timeliness statistics, preparing audit workpapers and sample listings, maintaining inquiry and sample-size spreadsheets, and compiling call details for telephone tape samples. The specialist performs basic audits and provides backup audit support. The position is based in Nashville, Tennessee, and requires Tennessee residency. It follows a hybrid arrangement requiring in-office work one to two days per week; candidates must live within reasonable commuting distance unless legally required accommodation is granted. Travel may be required for provider engagement or operational needs. The stated workshift is first shift.

Requirements

High school diploma or GED, at least five years of related experience, and a basic understanding of MTM processes and practices; or an equivalent combination of education and experience.
Tennessee residency.
Ability to work in-office one to two days per week in Nashville, Tennessee, and reside within reasonable commuting distance unless an accommodation is granted as required by law.

Nice To Haves

Experience supporting LTSS, CHOICES, ECF CHOICES, IDD, Medicaid waiver programs, or other long-term services and supports.
Knowledge of Person-Centered Planning and interdisciplinary care coordination.
Experience with provider collaboration, referral coordination, and service initiation processes.
Experience performing operational audits, quality reviews, or claims-related reporting.
Experience developing operational dashboards, data analytics, and performance reporting.
Experience leading projects, mentoring staff, or facilitating cross-functional initiatives.
Bachelor's degree in Healthcare Administration, Social Work, Human Services, Public Health, Business Administration, or a related field.
Strong analytical, problem-solving, and organizational skills, including the ability to interpret operational data, identify process improvement opportunities, manage multiple priorities, and meet deadlines.
Excellent verbal, written, and interpersonal communication skills and the ability to build collaborative relationships across members, providers, multidisciplinary teams, and internal stakeholders.
Proficiency with Microsoft Office applications, including Excel and Word, as well as healthcare information systems and reporting tools.

Responsibilities

Retrieve and verify receipt of system-generated reports, following up when reports are not received.
Enter claims timeliness statistics for each line of business processed on Amisys.
Create, update, and prepare workpapers for each sample.
Prepare claims sample listings.
Create, update, and maintain spreadsheets documenting weekly inquiry population and sample-size data.
Compile call details from individual workpapers for telephone tape samples.
Perform basic audits and assist with audits as backup.
Support timely initiation, coordination, and monitoring of services and contribute to operational reporting, quality assurance, data analysis, and process improvement.
Identify operational barriers, analyze trends, and recommend solutions to improve service delivery and member outcomes.