Performance Auditor Specialist

Elevance Health; Nashville (TN); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Hybrid work model

Paid time off

Medical benefits

401(k) match

Job summary

Elevance Health in Nashville, Tennessee seeks a Performance Auditor Specialist to support LTSS programs with data-driven oversight and process improvement. The role coordinates with members, providers, and care teams to ensure timely initiation, monitoring, and quality of LTSS services.

The position blends service coordination with operational support, including planning, reporting, and compliance activities.

Qualifications

• Requires HS diploma or GED and 5+ years related experience; understanding MTM processes.
• Preferred: LTSS knowledge, CHOICES, IDD, Medicaid waiver programs experience.
• Knowledge of Person-Centered Planning and interdisciplinary care coordination preferred.
• Experience with provider collaboration, referral coordination, and service initiation processes preferred.
• Experience with operational audits, quality reviews, or claims-related reporting preferred.
• Experience developing operational dashboards, data analytics, and performance reporting preferred.
• Experience leading projects, mentoring staff, or facilitating cross-functional initiatives preferred.
• Bachelor's degree in Healthcare Administration, Social Work, Public Health, or related field preferred.

Responsibilities

• Retrieves and verifies receipt of system generated reports and follows up when not received.
• Enters claims timeliness statistics for each line of business processed on Amisys.
• Creates, updates and prepares workpapers for each sample.
• Prepares all claims sample listings.
• Creates, updates and maintains spreadsheets documenting weekly inquiry population and sample size data.
• Compiles the call detail from individual workpapers for telephone tape samples.
• Performs basic audits and assists with audits as a backup.

Skills

LTSS knowledge

Data analytics

Quality reporting

Stakeholder collaboration

Microsoft Excel

Education

Bachelor's degree in Healthcare Administration

High School diploma or GED

Tools

Amisys

Excel

Word

Job description

Performance Auditor Specialist - LTSS Service Coordination & Operations

The role serves as a liaison among members, providers, care coordination teams, and internal stakeholders to ensure the timely initiation, coordination, and monitoring of services while supporting operational excellence through reporting, quality assurance, data analysis, and process improvement.

This position combines service coordination expertise with operational support responsibilities by facilitating person-centered care planning, monitoring service initiation activities, maintaining operational reporting, performing quality reviews, and supporting regulatory and contractual compliance. The specialist also serves as a resource to internal teams by identifying operational barriers, analyzing trends, and recommending solutions that improve service delivery and member outcomes.

Location: Nashville, Tennessee. Tennessee residency required.

Travel may be required to support provider engagement or operational needs.

Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

The Performance Auditor Specialist is responsible for providing technical and administrative support to Long-Term Services and Supports (LTSS) programs.

How You Will Make An Impact

• Retrieves and verifies receipt of system generated reports, following up when reports are not received.
• Enters claims timeliness statistics for each line of business processed on Amisys.
• Creates, updates and prepares workpapers for each sample.
• Prepares all claims sample listings.
• Creates, updates, and maintains spreadsheets documenting weekly inquiry population and sample size data.
• Compiles the call detail from individual workpapers for telephone tape samples.
• Performs basic audits and assists with audits as a backup.

Minimum Qualifications

Requires H.S diploma or GED; 5+ years related experience; basic understanding of MTM processes and practices; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities And Experiences

• Experience supporting LTSS, CHOICES, ECF CHOICES, IDD, Medicaid waiver programs, or other long-term services and supports preferred.
• Knowledge of Person-Centered Planning and interdisciplinary care coordination preferred.
• Experience with provider collaboration, referral coordination, and service initiation processes preferred.
• Experience performing operational audits, quality reviews, or claims-related reporting preferred.
• Experience developing operational dashboards, data analytics, and performance reporting preferred.
• Experience leading projects, mentoring staff, or facilitating cross-functional initiatives preferred.
• Bachelor's degree in Healthcare Administration, Social Work, Human Services, Public Health, Business Administration, or a related field preferred.
• Strong analytical, problem-solving, and organizational skills with the ability to interpret operational data, identify process improvement opportunities, manage multiple priorities, and meet deadlines preferred.
• Excellent verbal, written, and interpersonal communication skills, with the ability to build collaborative relationships across members, providers, multidisciplinary teams, and internal stakeholders preferred.
• Proficiency with Microsoft Office applications, including Excel and Word, as well as healthcare information systems and reporting tools preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.