Performance Auditor Specialist

Elevance Health•Nashville, TN

8d•Hybrid

About The Position

The role serves as a liaison among members, providers, care coordination teams, and internal stakeholders to ensure the timely initiation, coordination, and monitoring of services while supporting operational excellence through reporting, quality assurance, data analysis, and process improvement. This position combines service coordination expertise with operational support responsibilities by facilitating person-centered care planning, monitoring service initiation activities, maintaining operational reporting, performing quality reviews, and supporting regulatory and contractual compliance. The specialist also serves as a resource to internal teams by identifying operational barriers, analyzing trends, and recommending solutions that improve service delivery and member outcomes. The Performance Auditor Specialist is responsible for providing technical and administrative support to Long-Term Services and Supports (LTSS) programs.

Requirements

H.S diploma or GED
5+ years related experience
basic understanding of MTM processes and practices
any combination of education and experience, which would provide an equivalent background

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 with the ability to interpret operational data, identify process improvement opportunities, manage multiple priorities, and meet deadlines
Excellent verbal, written, and interpersonal communication skills, with 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

Retrieves and verifies receipt of system generated reports, following up when reports are not received.
Enters claims timeliness statistics for each line of business processed on Amisys.
Creates, updates and prepares workpapers for each sample.
Prepares all claims sample listings.
Creates, updates, and maintains spreadsheets documenting weekly inquiry population and sample size data.
Compiles the call detail from individual workpapers for telephone tape samples.
Performs basic audits and assists with audits as a backup.