Job Summary:
This position is responsible for phone and process audits across the department and conducts daily audits of work performed in assigned operational areas.
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Key Responsibilities:
1. Perform daily phone and process audits and follow standard processes and procedures for more complex positions as assigned.
2. Identify recurring issues for review. Make recommendations on less complex issues and escalate more complex issues
3. Display an in depth understanding of multiple review processes and workflows. Which may vary
4. Perform daily specified system processes from queue or on delivered reporting
5. Maintain consistent quality and production standards.
6. Mentor less experienced team members
7. Participate in special projects (recurring or initiatives) as assigned.
8. Maintain an understanding of and consistently display the ability to objectively think about goals and the intent of any assigned project.
9. Collaborate, coordinate, and communicate across disciplines and departments.
10. Ensure compliance with HIPAA regulations and requirements.
11. Demonstrate Company’s Core Competencies and values held within.
12. Please note due to the exposure of PHI sensitive data – this role is considered to be a High Risk Role.
13. The position responsibilities outlined above are in no way construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
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Job Scope:
This job works under general supervision to complete job responsibilities. The incumbent possesses and applies a range of knowledge gained through experience to complete the job responsibilities. One uses established guidelines and experience to resolve routine and sometimes complex issues and refers more complex issues to higher levels. Independent judgment is required to accomplish daily tasks and duties.
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Qualifications:
- Minimum HS Diploma (or GED)
- Minimum 2 years of industry related experience
- Required licensures, professional certifications, and/or Board certifications as applicable
- Quality assurance experience preferred
- Knowledge of insurance or healthcare industry
- Knowledge of claim payment and process preferred
- Communication (written, verbal and listening), interpersonal, time management, project and analytic skills
- Ability to understand methodology for multiple positions in order to identify issues.
- Ability to maintain consistent quality and production standards
- Ability to use software, hardware and peripherals related to job responsibilities including MS Office Suites, Word, Excel, Outlook, etc.
Pay: ₹200,000.00 - ₹600,000.00 per year
Benefits:
- Health insurance
- Provident Fund
Work Location: In person
