Operations Quality Auditor

AmeriHealth Caritas; Philadelphia (Philadelphia County); On-site; USD 60,000 - 90,000; Full time

Job summary

AmeriHealth Caritas is looking for an Operations Quality Auditor in Philadelphia, responsible for reviewing operational tasks like claims processing and data maintenance. The ideal candidate will have at least 3 years of Medicaid claims experience and a high school diploma. Join a mission-driven organization committed to improving health outcomes for communities.

Benefits

Flexible work solutions including remote options

401(k)

Tuition reimbursement

Paid time off including holidays and volunteer events

Health insurance coverage for you and your dependents on Day 1

Qualifications

• 3 years’ claims experience in a Medicaid environment required.
• Knowledge of Microsoft Office applications is a must.
• Experience in call center operations and member/provider database maintenance preferred.

Responsibilities

• Identifies operational issues and provides solutions.
• Documents audit findings in the quality tool.
• Reviews tasks performed by Operations for quality standards.

Skills

Claims processing knowledge

Attention to detail

Problem-solving

Communication

Education

High School/GED

Tools

Microsoft Office

Facets system

Job description

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Role Overview

Under the direct supervision of the Supervisor, Manager, and/or Director of Operations Quality Auditing, the Operations Quality Auditor is 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).

Role Overview

Under the direct supervision of the Supervisor, Manager, and/or Director of Operations Quality Auditing, the Operations Quality Auditor is 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).

Responsibilities

• 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 And 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
  
  

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 Newtown Square, PA, 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.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance

• Industries

  Hospitals and Health Care

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