Quality Assurance Spec

GEHA; Lee's Summit (MO); On-site; USD 48,000 - 67,000; Full time

Benefits offered by this job

Health/Vision/Dental benefits start on

401(k) retirement plan with company/m‑

Paid Time Off

Tuition Assistance Program

Job summary

GEHA is offering a remote opportunity for a Quality Assurance Specialist with a focus on audits, reports, and provider data management. The role requires strong communication and MS Office proficiency, with a path to impact quality across departments.

The position is based in the Kansas City area with hybrid/work-from-home options and salary information outlined by the company. Applicants should be able to meet home-office internet requirements.

Qualifications

• Requires an associate's degree; additional experience may substitute.
• Requires 4 years of related experience.
• Strong written and verbal communication skills.
• Proficiency with MS Word and MS Excel.
• Thorough knowledge of Provider Data Management policy.

Responsibilities

• Update and complete daily, monthly, and annual reports.
• Prepare responses to correspondence and manage complex provider issues.
• Answer questions from PDM staff and other departments about provider updates.
• Make recommendations to improve quality and workflows.
• Assist with department training and cross-functional projects.
• Analyze audit reports and identify trends for outcomes.

Skills

Communication

MS Word

MS Excel

PDM policy knowledge

Education

Associate's degree

Tools

MS Word

MS Excel

Job description

Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. G.E.H.A has one mission: To empower federal workers to be healthy and well.

The Quality Assurance Specialist audits claims coding, customer service calls or electronic files for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures.

Duties and Responsibilities

• Updates and completes daily, monthly, and annual reports.
• Prepares responses to correspondence and manages complex provider issues and calls.
• Answers questions from PDM staff and other departments regarding provider updates and issues.
• Makes recommendations to improve quality, workflow processes, policies, and procedures.
• Credentialing: Chairperson SAL Audit VP Files (CVO Initial & CVO Re-Creds) WAP Audit OGM Invalid License IH Initial & Re-Creds Cred Verification MS Review Audit Contract Audit Provider Verification: Provider Relations: Call Audits Service Issue Audit Case Audit Audit Errors Assists with department training.
• Contributes independently and collaboratively across departments and cross-functional projects.
• Analyzes audit reports and rebuttals to identify trends and recommend determination of outcome.
• Reviews and makes suggestions for changes/updates to training materials and existing desk-level procedures and policies.

Knowledge, Skills, and Abilities

• Requires an associate's degree.
• Will consider additional experience in lieu of degree.
• Requires 4 years of related experience.
• Requires effective written and verbal communication skills to answer questions from staff and providers.
• Requires proficiency with MS Word and MS Excel.
• Must have thorough knowledge of Provider Data Management policy and procedures.

Preferred Qualifications

• Experience as an Associate Quality Assurance Specialist within PDM.

Work‑at‑home requirements

Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

How we value you

• Competitive pay/salary ranges
• Incentive plan
• Health/Vision/Dental benefits effective day one
• 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
• Robust employee well-being program
• Paid Time Off
• Personal Community Enrichment Time
• Company-provided Basic Life and AD&D
• Company-provided Short-Term & Long-Term Disability
• Tuition Assistance Program
• Benefits start on day one!
• Great 401(k) match!
• Tuition assistance programs!
• Professional development!
• Advancement opportunities!

While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine.

Salary information: The target hiring range for this position is $47,808 - $60,480 USD. At G.E.H.A, the current maximum salary for this role is $67,392 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization.

G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees.

G.E.H.A is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.

For additional information, please visit GEHA Careers.