About this role

Log and track data to be audited
Audit outgoing correspondence from the Medical Review, Appeals, and Refund teams
Conduct complete audit of claim adjustments by the Rapid Response team
Communicate and coordinate with other departments involved in the audit process
Audit new and existing plans built by plan coders for all new and existing revisions
Assist with current audit programs in place as well as identify ways to improve audit results
Track and report audit trends and communicate training requirements to Management based on audit results
Monitor and track audit progress to ensure all audit task are complete by the determined deadline
Audit data for accuracy as well as workflow compliance
Other duties as assigned

Bachelor's degree or equivalent work experience required.
Minimum 5 years of comprehensive experience with auditing medical, dental, and vision claims required.
Proficient in Microsoft Word and Microsoft Excel
Some familiarity with plan coding.
Strong written and verbal communication skills required.
Ability to effectively manage assigned workload, including multiple task and competing priorities.

Quality Assurance Auditor

Key skills