Quality Assurance Analyst

Highmark Health•Washington, DC

2d•$23 - $36•Onsite

About The Position

This job performs transactional non-clinical quality audits and tasks in compliance with all regulatory compliance guidelines, UM Contracted Clients as well as contractual Performance Guarantees and other operational quality process improvement efforts. Maintains accurate audit documentation and is required to follow appropriate audit guidelines as well as department and Corporate policies and procedures.

Requirements

3 years in Claims Support and Processing
3 years in Customer Service
3 years in Billing
3 years in Enrollment
3 years in Benefits Administration
3 years in Utilization Management
Auditing
Claims Processing
Customer Service
Billing Systems
Benefit Coding
Enrollment Systems
Utilization Management Systems

Nice To Haves

Bachelor's Degree in Business Administration/Management, Accounting, Health Administration or General Studies

Responsibilities

Perform a complete review and analysis of transactions as required by all regulatory compliance guidelines, UM Contracted Clients as well as contractual Performance Guarantees and other operational quality efforts to determine accuracy and compliance with guidelines and contractual obligations.
Possess a thorough understanding of operational procedures and systems within the process being audited.
Manage individual inventory of audit work to meet department quality standards.
Participate in special project work as needed.
Effectively utilize audit tool to manage audit case inventory, document audit samples and describe and support audit findings and communicate them to internal and external customers as appropriate.
Obtaining source documentation, validating it is accurate and complete in compliance with guidelines and reporting requirements.
Maintain scorecard entries in audit tool accurately and consistently meet all production standards established in departmental protocol.
Monitor various mediums to ensure awareness of most current information available via the Knowledge Center, Compass for UM, and/or other resources to apply to auditing determinations.
Share relevant information with the team when received individually through normal work channels.
Other duties as assigned.