Performance Quality Analyst II

CareBridge-posted 2 months ago
Full-time • Mid Level
Cincinnati, OH
251-500 employees
Ambulatory Health Care Services
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The Performance Quality Analyst II is responsible for driving service quality excellence by evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.

  • Assists higher level auditor/lead on field work as assigned and acts as auditor in charge on small and less complex audits.
  • Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment & billing transactions and the corrective action plan process.
  • Demonstrates ability to audit multiple lines of business, multiple functions, and multiple systems.
  • Analyzes and interprets data and makes recommendations for change based on judgment and experience, applies audit policy, and assesses risks to minimize our exposure and mitigate those risks.
  • Works closely with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops and recommends process improvements and solutions.
  • Functions as a subject matter expert for discrepancy review, questions from team and business partners, and interpretation of guidelines and audit process.
  • Acts as a mentor to peer auditors, providing training and managing work and projects as necessary.
  • Requires a BS/BA.
  • A minimum of 3 years related experience in an enrollment and billing, claims and/or customer contact automated environment (preferably in healthcare or insurance sector), including a minimum of 1 year related experience in a quality audit capacity.
  • Any combination of education and experience, which would provide an equivalent background.
  • WGS Claims processing experience strongly preferred.
  • Experience/knowledge with local claim processing.
  • Understanding of individual member benefits and cost shares preferred.
  • Understanding of small, large and national group benefits and cost shares preferred.
  • Prefer contract language.
  • Merit increases
  • Paid holidays
  • Paid Time Off
  • Incentive bonus programs
  • Medical benefits
  • Dental benefits
  • Vision benefits
  • Short and long term disability benefits
  • 401(k) + match
  • Stock purchase plan
  • Life insurance
  • Wellness programs
  • Financial education resources
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