Job Description
POSITION SUMMARY
The Quality Assurance Auditor will be responsible for the completion of multiple audit tasks including but not limited to auditing the building 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 identifying 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 tasks 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 AND 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 tasks and competing priorities
COMPETENCIES
• Accountability
• Analytical Thinking
• Collaboration
• Communication
• Customer Focus
• Functional Expertise
• Initiative
PHYSICAL DEMANDS
• This is a standard desk job 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 and 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.