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Job Details

Quality Review/Audit Sr Assoc

Nashville, TN

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Quality Review/Audit Sr Assoc','18002533','!*!Hours: 8am - 4:30pm CST
Role Summary:
This position is responsible for conducting audits to ensure compliance and accuracy of the assigned business area.  This will include assisting in the development of audit tools and recommending changes in processing procedures.  As a member of the Customer & Client Service Experience (CCSE) Ops Internal Monitoring Team, the incumbent will have the ability and be expected to drive change, and positively impact the accuracy and efficiency of **MEMBERS ONLY**SIGN UP NOW***. Healthspring’s operations by recommending actions that address error trends and root-causes of errors found during quality audits.

Complete assigned audits in a timely manner

Follow up and respond to inquiries from the auditee regarding audit work performed

Identify and report error trends to Management

Work with management in developing appropriate remediation steps to address audit findings and error trends

Train other auditors and create job aids and other related material for the CCSE Ops Internal Monitoring department

Develop subject matter expertise in areas audited and become resource for the team

Ability to meet production demands and maintain a high level of quality.  This may include occasional overtime, especially during the peak seasons

Supports and drives process improvement to further enhance service outcomes; opportunities for streamlining processes and procedures, reducing rework

Supports and reinforces updated and/or new information; SOPs, tools, system enhancements, workflows, etc.

Knowledge of CMS Chapter 13 Managed Care Manual

Knowledge of CMS ODAG Audit Protocols

Working knowledge of Microsoft Word & Access, SharePoint, and Lync, with intermediate proficiency level of Excel.

Experience in quality review/auditing

Skilled in analyzing quality results

Proven confidence in the usage and application of all tools, workflows, and processes in current role

Minimum 3 years’ experience in a managed care or related field

Possess an understanding of operational and compliance auditing

Exceptional verbal and written communication skills

Work independently and with the team with minimal oversight and supervision

Ability to meet strict timelines

Strong interpersonal skills to work with many different personalities and styles

Capable of explaining complex issues in a concise manner

Detail oriented
 ','Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: ****','United States-Tennessee-Nashville','','500 Great Circle Road','','Nashville','37228','Bus Ops--Quality Assur/Audit','Yes','Yes','Full-time','Day Job','Regular','Standard','Individual Contributor','No','Jul 12, 2018','Quality Review/Audit Sr Assoc

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