Performance Auditor

Jefferson Health; Philadelphia, Northern (Philadelphia County, KY); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

AD&D insurance

Disability benefits

Retirement plans

Tuition assistance

Voluntary benefits

Job summary

Jefferson Health is seeking a Performance Auditor to plan and conduct quality audits within Health Partners Plans, focusing on Enrollment operations. The role requires proficiency in QA audits, risk assessment, and clear reporting under professional standards.

The ideal candidate will develop audit programs, test procedures, and communicate results effectively, collaborating with the Sr. Performance Auditor and cross-functional teams.

Qualifications

• Associate’s Degree in a relevant field, or a high school diploma with health insurance QA/audit experience.
• Two+ years in managed care/health insurance customer service, audit or quality assurance.
• Working knowledge of enrollment systems that support the Enrollment business unit.
• Outstanding analytical, interpersonal, and written communication skills.
• HIPAA knowledge and medical terminology.
• MS Office skills.

Responsibilities

• Execute a wide variety of audit tests and interpret results against defined criteria.
• Identify and measure operational and compliance risks; formulate practical, cost-effective recommendations.
• Document relevant facts and information to support work and conclusions.
• Evaluate audit results for relevancy, accuracy, and context against evidence.
• Communicate audit results clearly in writing and verbally to stakeholders.
• Conduct audits per professional and departmental standards; seek guidance when needed.
• Complete assignments independently or as part of a team.
• Interact professionally with others and manage time to meet deadlines.
• Recommend improvements to audit practices and processes.

Skills

Analytical skills

Interpersonal skills

Written communication

Communication skills

Time management

Creativity

Medical terminology

Education

Associate’s Degree in a relevant field

High School Diploma or GED

Tools

MS Office

Enrollment systems

Job description

**Job Details**Under the general direction of the Manager, Performance Audit, the Performance Auditor is responsible for the completion of Quality Audits / Reviews within the Health Partners Plans Organization. This particular position will plan and conduct operational audits to support the Enrollment department. The Performance Auditor is expected to have experience and demonstrate proficiency in performing quality assurance audits/reviews, which conform to professional audit standards. The Performance Auditor will assist the Sr. Performance Auditor with planning, development of audit programs for audit testing and evaluation, and reporting of audit results. The complexity and size of audit assignments varies.**Job Description** **Summary** Under the general direction of the Manager, Performance Audit, the Performance Auditor is responsible for the completion of Quality Audits / Reviews within the Health Partners Plans Organization. This particular position will plan and conduct operational audits to support the Enrollment department. The Performance Auditor is expected to have experience and demonstrate proficiency in performing quality assurance audits/reviews, which conform to professional audit standards. The Performance Auditor will assist the Sr. Performance Auditor with planning, development of audit programs for audit testing and evaluation, and reporting of audit results. The complexity and size of audit assignments varies. **Job Duties*** Executes a wide variety of audit tests/procedures and accurately interprets results against defined criteria.* Understands the operational and compliance risks that affect HPP’s Operations; demonstrates the ability to identify and appropriately measure those risks; and formulates recommendations that are appropriate, practical, and cost-effective.* Consistently documents relevant facts and information to support the work performed and conclusions drawn so operations representatives can follow the auditor's logic and methodology.* Effectively evaluates audit results, weighing the relevancy, accuracy, and perspective of conclusions against the accumulated audit evidence.* Effectively communicates audit results, both verbally and in writing, so they are clear and concise, placed in the appropriate context, and understood by the recipient.* Conducts audits in accordance with professional and departmental standards.* Knows when to seek guidance from supervising staff as circumstances warrant.* Completes work assignments independently or as part of a team project.* Interacts effectively with others in a professional manner.* Demonstrates effective time management skills by completing assignments within assigned timeframes.* Exhibits creativity and innovation in recommending improvements to departmental audit practices and processes. **Minimum Qualifications*** Associate’s Degree from an accredited university / college in a relevant course of study or* High School Diploma/GED in the absence of college coursework, at least two years in managed care or health insurance customer service, audit or quality assurance experience with a minimum of 4 years proficiency in a health insurance operational function will be considered* Working knowledge of current Applications and Core Systems that support the Enrollment business unit.* Outstanding analytical, interpersonal, and written communication skills.* Ability to communicate effectively.* Medical Terminology* working knowledge of HIPAA, and other related regulations* MS Office skills. **Physical Demands** Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, \\*patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR. Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.**Work Shift**Workday Day (United States of America)**Worker Sub Type**Regular**Employee Entity**Health Partners Plans, Inc.**Primary Location Address**901 Market Street, Philadelphia, Pennsylvania, United States of AmericaNationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. **Benefits**Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.