Performance Auditor - Jefferson Health Plan

Jefferson Health Plans • Philadelphia, PA

4d • Onsite

About The Position

Under the general direction of the Manager, Performance Audit, the Performance Auditor is responsible for the completion of Quality Audits / Reviews within the Health Partners Plans Organization. This particular position will plan and conduct operational audits to support the Enrollment department. The Performance Auditor is expected to have experience and demonstrate proficiency in performing quality assurance audits/reviews, which conform to professional audit standards. The Performance Auditor will assist the Sr. Performance Auditor with planning, development of audit programs for audit testing and evaluation, and reporting of audit results. The complexity and size of audit assignments varies.

Requirements

• Associate’s Degree from an accredited university / college in a relevant course of study or High School Diploma/GED in the absence of college coursework
• at least two years in managed care or health insurance customer service, audit or quality assurance experience
• a minimum of 4 years proficiency in a health insurance operational function will be considered
• Working knowledge of current Applications and Core Systems that support the Enrollment business unit.
• Outstanding analytical, interpersonal, and written communication skills.
• Ability to communicate effectively.
• Medical Terminology
• working knowledge of HIPAA, and other related regulations
• MS Office skills.

Responsibilities

• Executes a wide variety of audit tests/procedures and accurately interprets results against defined criteria.
• Understands the operational and compliance risks that affect HPP’s Operations; demonstrates the ability to identify and appropriately measure those risks; and formulates recommendations that are appropriate, practical, and cost-effective.
• Consistently documents relevant facts and information to support the work performed and conclusions drawn so operations representatives can follow the auditor's logic and methodology.
• Effectively evaluates audit results, weighing the relevancy, accuracy, and perspective of conclusions against the accumulated audit evidence.
• Effectively communicates audit results, both verbally and in writing, so they are clear and concise, placed in the appropriate context, and understood by the recipient.
• Conducts audits in accordance with professional and departmental standards.
• Knows when to seek guidance from supervising staff as circumstances warrant.
• Completes work assignments independently or as part of a team project.
• Interacts effectively with others in a professional manner.
• Demonstrates effective time management skills by completing assignments within assigned timeframes.
• Exhibits creativity and innovation in recommending improvements to departmental audit practices and processes.

Benefits

• medical (including prescription)
• supplemental insurance
• dental
• vision
• life and AD&D insurance
• short- and long-term disability
• flexible spending accounts
• retirement plans
• tuition assistance
• voluntary benefits
• tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree