Performance Auditor

Health Partners Plans, Inc.; United States; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Tuition assistance

Retirement plans

Job summary

Health Partners Plans, Inc. is seeking a Performance Auditor to conduct quality audits and operational reviews in support of the Enrollment department. Under the Manager, Performance Audit, you will plan audit programs, perform testing, and report findings with professional rigor.

You’ll assist senior staff in developing tests and evaluating results, while managing time and communicating clearly. The role emphasizes independent work, risk assessment, and practical, cost-effective recommendations

Qualifications

• Under the general direction of the Manager, Performance Audit, plans and conducts audits.
• Experience in quality assurance audits/reviews following professional standards.
• Ability to develop audit programs, test plans, and report results.

Responsibilities

• Executes a wide variety of audit tests and interprets results.
• Identifies operational and compliance risks and makes recommendations.
• Documents facts and information to support conclusions and audit trail.
• Communicates audit results clearly, both verbally and in writing.
• Conducts audits per professional/department standards.
• Completes assignments independently or in teams.
• Interacts professionally with others and manages time effectively.
• Suggests improvements to audit practices and processes.

Skills

Analytical skills

Interpersonal skills

Written communication

HIPAA knowledge

MS Office

Education

Associate's degree or high school diploma

Tools

Enrollment systems experience

Job description

Number of Positions In Requisition 2 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 America

About Jefferson

Nationally 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

• medical (including prescription)
• supplemental insurance
• dental
• vision
• life and AD&D insurance
• short- and long-term disability
• flexible spending accounts
• retirement plans
• tuition assistance
• 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.
• For more benefits information, please click here.

In keeping with Jefferson's Mission, We Improve Lives, it is our goal to recruit, retain, develop and reward highly-qualified employees. If you are enthusiastic, caring and dedicated to service excellence, we invite you to consider joining Jefferson. Jefferson encourages its employees to expand their knowledge and develop their careers through growth opportunities and continuing education. With a long standing history, Jefferson has been advancing the medical field from the heart of Center City Philadelphia for nearly 200 years. Our Mission, We Improve Lives, expands to every corner of the organization. From our weekly farmer’s market, to our new Jefferson Accelerator Zone for innovation, our employees’ passion for the community is evident by the daily gestures towards our patients, students and each other.