Job Information
Healthfirst Bilingual Spanish Clinical Auditors in Remote, Pennsylvania
This position is Remote
Perform routine random/target audits of operational processes (e.g., call centers, enrollment/terminations, invoicing/dunning, member/provider notifications, workforce management, sales/retention, etc.) across multiple lines of business and products
Confirm employee adherence to company, state and federal policies and procedures including compliance and regulatory guidelines
Prepare written audit reports on findings and communicates audit findings with appropriate leadership
Identify quality, operational efficiency, and production goal defects to support the improvement of departmental performance
Identify patterns, trends and variances related to audited performance and provide feedback to appropriate leaders
Meet established time frames and rates of performance for both quality and quantity of work
Conduct compliance audits to ensure members and/or provider accounts are accurately and timely handled according to contracted and regulatory guidelines
Provide suggestions and recommendations on improving controls to gain efficiency and strengthening of performance and compliance measures
Assist in the development of departmental policies and procedures
Review the accuracy and efficiency of existing training materials
Comply with HIPAA guidelines and maintain confidentiality of employee, member, provider, medical and departmental information
Additional duties as assigned
MinimumQualifications:
Healthcare operations experience working in a Quality Assurance, contact center, member enrollment and billing, or provider data management
Prior working experience with Microsoft Office suite of applications including Excel (which includes formatting formulas, managing data, and filtering results), Word, PowerPoint, and Outlook
Experience conducting analytical work and providing creative ideas for problem solving
Work experience requiring written and verbal communication that is clear, concise, grammatically correct, and professional
High School Diploma or GED from an accredited institution
Preferred Qualifications:
Experience handling Personal Health Information (PHI) in a professional manner
Experience in an Auditing capacity where you have conducted root cause analysis
Ability and willingness to handle increasing workload and responsibility
Willingness and ability to learn and evaluate new information, both technical and procedural
Knowledge of at least two or more lines of business such as NY Medicare, Medicaid, Family Health Plus, or Child Health Plus, etc.
Associate degree or higher
Compliance & Regulatory Responsibilities: See Above
License/Certification: N/A
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.