Quality Audit Analyst

Health Care Service Corporation•Helena, MT

20h•$41,700 - $92,800•Hybrid

About The Position

This Position Is Responsible For Planning And Conducting Detailed Audits, Analyzing Programs, Related To Quality And Performance. Review Business Transactions Such As Claims, Inquiry Or Membership, Processes Etc To Assure That: A) Internal Controls And Model Audit Rule Requirements Are Adhered To, And B) Processing Is Performed Timely, Accurately, And Completely In The Appropriate Systems In Accordance With Standard Business Processes.

Requirements

Bachelor degree and 2 years experience auditing claims, inquiry or membership within the health insurance industry OR 6 years experience auditing claims, inquiry or membership within the health insurance industry.
Knowledge of the various Blue Chip processing systems (i.e., BlueSTAR, CFE, etc.) contract administration, and medical terminology.
Analytical and research skills.
Clear and concise written and verbal communication skills.
Organizational and multi-tasking skills to manage daily work load and meet aggressive deadlines and timetables.
Knowledge of state contract provisions.
Knowledge with sold case materials, departmental documents.
PC proficiency to include Word, Excel, PowerPoint, EPPS, NICE, Live Meeting/WebEx and Lotus Notes.
Experience meeting deadlines.

Nice To Haves

Quality audit experience
Knowledge of health insurance products.

Responsibilities

Planning and conducting detailed audits related to quality and performance.
Analyzing programs related to quality and performance.
Reviewing business transactions such as claims, inquiry, or membership processes.
Ensuring adherence to internal controls and Model Audit Rule requirements.
Verifying that processing is performed timely, accurately, and completely in the appropriate systems in accordance with standard business processes.