The Quality Assurance Auditor will independently and collaboratively complete multiple audit tasks, including auditing plan builds, outgoing correspondence from various teams, and claim adjustments. Responsibilities also involve interpreting plan benefits to determine payment tracking and reporting within the QicLink system.
Requirements summary
Candidates must possess a minimum of five years of comprehensive experience auditing medical, dental, and vision claims, along with a Bachelor's degree or equivalent work experience. Proficiency in Microsoft Word and Excel, strong communication skills, and the ability to manage competing priorities are also required.
Category: OperationsPOSITION 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.
Proficient in Microsoft Word and Microsoft Excel
Some familiarity with plan coding
Strong written and verbal communication skills required
Ability to effectively manage assigned workload, including multiple task and competing priorities COMPETENCIES Accountability Analytical Thinking Collaboration Communication Customer Focus Functional Expertise Initiative PHYSICAL DEMANDS
Benefits
Dental Insurance
Disability Insurance
Life Insurance
Paid Time Off
Vision Insurance
Medical Insurance
Tuition Reimbursement
Eap
Technology Stipend
This is an office environment requiring extended sitting and computer work WORK ENVIRONMENT
Remote Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive. 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. Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend. Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role. Qualifications
More openings at Allied Benefit Systems
No additional openings are live from this employer right now.
