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Quality Assurance Auditor - Medical Claims
Chicago, IL
Job Description
QUALITY ASSURANCE AUDITOR
POSITION SUMMARY
Working independently and in groups the Quality Assurance Auditor will be responsible for the completion of multiple audit tasks including but not limited to auditing the builds of plan coders as needed for all new and existing revisions, along with compiling and reporting results and trends accurately. The QA Auditor is also responsible for auditing outgoing correspondence from the Medical Review, Appeals, and Refund teams, as well as complete audit of claim adjustments by the Rapid Response team. The QA Auditor will interpret the benefits in the plan documents to determine how benefits are payable and tracked/reported in the QicLink system.
ESSENTIAL FUNCTIONS
POSITION SUMMARY
Working independently and in groups the Quality Assurance Auditor will be responsible for the completion of multiple audit tasks including but not limited to auditing the builds of plan coders as needed for all new and existing revisions, along with compiling and reporting results and trends accurately. The QA Auditor is also responsible for auditing outgoing correspondence from the Medical Review, Appeals, and Refund teams, as well as complete audit of claim adjustments by the Rapid Response team. The QA Auditor will interpret the benefits in the plan documents to determine how benefits are payable and tracked/reported in the QicLink system.
ESSENTIAL FUNCTIONS
- Log and track data to be audited
- Audit outgoing correspondence from the Medical Review, Appeals, and Refund teams
- Conduct complete audit of claim adjustments by the Rapid Response team
- Communicate and coordinate with other departments involved in the audit process
- Audit new and existing plans built by plan coders for all new and existing revisions
- Assist with current audit programs in place as well as identify ways to improve audit results
- Track and report audit trends and communicate training requirements to Management based on audit results
- Monitor and track audit progress to ensure all audit task are complete by the determined deadline
- Audit data for accuracy as well as workflow compliance
- Other duties as assigned
EDUCATION
- Bachelor's degree or equivalent work experience required.
EXPERIENCE & SKILLS
- Minimum 5 years of comprehensive experience with auditing medical, dental, and vision claims required
- Experience working at a TPA or Health Insurance company strongly preferred
- Proficient in Microsoft Word and Microsoft Excel
- Some familiarity with plan coding preferred
- Strong written and verbal communication skills required
- Ability to effectively manage assigned workload, including multiple task and competing priorities
COMPETENCIES
- Job Knowledge
- Time Management
- Accountability
- Communication
- Initiative
- Customer Focus
PHYSICAL DEMANDS
This is an office environment requiring extended sitting and computer work
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WORK ENVIRONMENT
Remote
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
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WORK ENVIRONMENT
Remote
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
5+ years
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