Enrollment Quality Assurance Auditor

Socket.dev; Philadelphia (Philadelphia County); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical insurance

Tuition assistance

Retirement plans

Job summary

Health Partners Plans, Inc. is seeking a Performance Auditor to plan and execute quality audits in the Enrollment domain. The role requires proficiency in audits/reviews per professional standards and the ability to develop audit programs, test plans, and report results.

Collaboration with the Senior Auditor and cross-functional teams is expected as audit complexity varies. Responsibilities include executing diverse audit tests, identifying risks, documenting evidence, and communicating results

Qualifications

• Associate’s Degree or equivalent; strong communication and analytical skills required.
• Two years in managed care or health insurance customer service, audit, or quality assurance with four years of health insurance operations experience.
• Working knowledge of Enrollment systems and core applications.
• Excellent written and verbal communication, and HIPAA familiarity.

Responsibilities

• Executes audits and tests and interprets results against criteria.
• Identify operational risks and propose practical, cost-effective mitigations.
• Document facts and methods to support conclusions for audit trails.
• Evaluate results against evidence and communicate findings clearly.
• Perform audits per professional and departmental standards; seek guidance when needed.
• Complete work independently or in teams; interact professionally with others.
• Manage time to complete assignments within deadlines.

Skills

Analytical skills

Interpersonal skills

Written communication

Effective communication

Medical Terminology

HIPAA knowledge

MS Office skills

Education

Associate’s Degree in a relevant field

High School Diploma or GED with relevant experience

Tools

MS Office

Job description

Health Partners Plans, Inc. is seeking a Performance Auditor to plan and execute quality audits in the Enrollment domain. The role requires proficiency in audits/reviews per professional standards and the ability to develop audit programs, test plans, and report results.

Collaboration with the Senior Auditor and cross-functional teams is expected as audit complexity varies. Responsibilities include executing diverse audit tests, identifying risks, documenting evidence, and communicating results