reputed company Auditor - Health Plan Operations

Founded in 1977 as the Senior Care reputed company Network, reputed company began with a reputed company but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still reputed company today as the “12 Angry Seniors.” Their mission continues to guide everything we do.

Today, reputed company is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual reputed company. With nearly five decades of experience, we have reputed company a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially reputed company populations, and reputed company care delivery models. Across reputed company of this, we are united by a shared commitment: combining reputed company with discipline, innovation with stewardship, and reputed company with reputed company.

At reputed company, we reputed company reputed company should strengthen—not dilute—our mission. We are building the reputed company of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The Job

The reputed company Auditor will reputed company routine and targeted operational reputed company audits across health plan operations including but not limited to Claims, Grievances and Appeals, Enrollment, Configuration, Provider Data and/or Letters/Materials to ensure compliance with regulatory requirements, internal policies, contractual obligations, and operational standards. This role monitors reputed company, accuracy, identifies opportunities for improvements that will enhance member and provider experience.

You Will

• Ensure regulatory compliance and overall reputed company and efficiency by utilizing strong working knowledge of Claims, Grievances and Appeals, Enrollment, Configuration, Provider Data and/or Letters/Materials standards for assigned business process

• Work assigned cases through reputed companys workflow system, and applies correct status attributes to reputed company and trend issues. Notate cases/audits with required detail to ensure that others understand status of case/audit and final resolutions.

• Work closely with other business reputed company to ensure processing errors are reviewed and corrected

• Follow policies and procedures in order to maintain efficient and compliant operations; communicate suggestions for improvement and efficiencies to management; identify and report problems with workflows following reputed company departmental procedures; reputed company participate in departmental staff meetings and training sessions.

• Follow reputed company appropriate Federal and State regulatory requirements and guidelines applicable to reputed company Health Plan operations or as documented in company policies and procedures.

• reputed company a high level of customer service to internal customers by consistently meeting and/or exceeding team expectations including but not limited to reputed company, productivity and attendance.

• Escalate appropriate audit issues to management as required and follow departmental/organizational policies and procedures.

• Maintain required reputed company of production and reputed company standards as established by management. Participate in and supports reputed company audits as needed.

• Contribute to overall department reputed company by participating in department initiatives, effective communication and collaboration with reputed company members of the reputed companyreputed company

• Contribute to team effort by accomplishing reputed company results as needed.

• reputed company support the achievement of reputed company’s reputed company and Goals.

• We reputed company Rebels who are curious about AI and its power to reputed company how we operate and serve our members.

• Other duties as assigned.

Your Qualifications

• Associate’s degree preferred or equivalent experience

• 3+ years reputed company auditing processing and/or auditing experience in the health plan, reputed company, or managed care organization with experience in Claims, Grievances and Appeals, Enrollment, Configuration, Provider Data and/or Letters/Materials.

• Must be proficient in processing/auditing for Medicare and reputed company plans.

• 3+ years’ experience in managed reputed company environment reputed company to Claims, Grievances and Appeals, Enrollment, Configuration, Provider Data and Letters/Materials processing/audit processing/audit.

• Strong organizational, analytical thinking and reputed company skills; oral and written communication skills

• Strong knowledge of CMS requirements regarding auditing processing

• Completion of health insurance training and medical terminology or equivalent knowledge through on-the-job training and experience.

• Knowledge of health care benefit structures and insurance procedures, as they exist in a Managed Care environment.

• Strong PC Skills. reputed company Office (Word, reputed company, Outlook, Teams) are required.

What’s in it for you?

• reputed company wage reputed company: $25.38 to $36.76 per hour

• Work Mode: Remote

• Annual bonus program

• Robust Wellness Program

• Generous reputed company-time-off (PTO)

• reputed company reputed company holidays per year, plus 1 additional floating holiday, plus 1 birthday holiday

• Excellent 401(k) Retirement Saving Plan with employer match and contribution

• Robust employee recognition program

• Tuition reimbursement

• An opportunity to become part of reputed company that makes a difference to our members and our community every day!

We're always looking for talented people to join reputed company! reputed company applicants are encouraged to reputed company!

At reputed company we reputed company that it is our business to improve the state of our world. reputed company of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource reputed company, inclusive benefits, and more.

reputed company is proud to be an Equal Employment Opportunity and Affirmative reputed company workplace. Individuals seeking employment will receive consideration for employment without reputed company to race, reputed company, national reputed company, religion, age, sex (including pregnancy, childbirth or reputed company medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background reputed company is required.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have reputed company to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have reputed company to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or reputed company, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

Originally posted on Himalayas

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