Quality Assurance Analyst

Job Summary This job performs transactional non-clinical quality audits and tasks in compliance with all regulatory compliance guidelines, UM Contracted Clients as well as contractual Performance Guarantees and other operational quality process improvement efforts. Maintains accurate audit documentation and is required to follow appropriate audit guidelines as well as department and Corporate policies and procedures. Essential Responsibilities Perform a complete review and analysis of transactions as required by all regulatory compliance guidelines, UM Contracted Clients as well as contractual Performance Guarantees and other operational quality efforts to determine accuracy and compliance with guidelines and contractual obligations. Possess a thorough understanding of operational procedures and systems within the process being audited. Manage individual inventory of audit work to meet department quality standards. Participate in special project work as needed. Effectively utilize audit tool to manage audit case inventory, document audit samples and describe and support audit findings and communicate them to internal and external customers as appropriate. Obtaining source documentation, validating it is accurate and complete in compliance with guidelines and reporting requirements. Maintain scorecard entries in audit tool accurately and consistently meet all production standards established in departmental protocol. Monitor various mediums to ensure awareness of most current information available via the Knowledge Center, Compass for UM, and/or other resources to apply to auditing determinations. Share relevant information with the team when received individually through normal work channels. Other duties as assigned. Education Required High School Diploma/GED Preferred Bachelor's Degree in Business Administration/Management, Accounting, Health Administration or General Studies Experience Required (one or more of the following) 3 years in Claims Support and Processing 3 years in Customer Service 3 years in Billing 3 years in Enrollment 3 years in Benefits Administration 3 years in Utilization Management Preferred None Skills Auditing Claims Processing Customer Service Billing Systems Benefit Coding Enrollment Systems Utilization Management Systems Travel Requirement 0% - 25% Position Type Office-based Physical, Mental Demands and Working Conditions Lifting: up to 10 pounds (constant); 10 to 25 pounds (occasionally); 25 to 50 pounds (rarely). Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. Employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with HIPAA and all data security guidelines. The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. EEO Statement Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. Pay Range Minimum: $23.16 Maximum: $35.88 #J-18808-Ljbffr