Operations Quality Auditor - Claims
Amerihealth
Job Info
Your career starts now. We're looking for the next generation of health care leaders.
At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Responsibilities:
Under the direct supervision of the Supervisor, Manager and/or Director of Operations Quality Auditing, responsible for the timely and accurate review of various tasks performed by Operations (including, but not limited to, claims processing, call handling and member/provider data maintenance). Identifies system and/or operational issues hindering the attainment of quality performance standards as defined by AMFC policy and associated business rules. Provides issue identification, problem analysis and strategies for resolution and/or implementation to Management. Accurately documents audit findings in the appropriate quality tool.
Education/Experience:
- High School/GED required.
- Minimum 3 years' claims experience in a Medicaid environment.
- Claims processing knowledge required, preferably with the Facets system.
- Working knowledge of Microsoft Office applications.
- Experience in Call Center Operations and Member/Provider database maintenance preferred.
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