Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
Preferred Location: Mason, OH.
The Quality Configuration Audit Senior is responsible for driving service quality excellence by evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to provider and pricing configuration and respective downstream processes, as will as provider inquires.
How you will make an impact:
Acts as auditor in charge for audits and special projects, producing engagement planning and testing strategies.
Translates business need into appropriate, comprehensive quality validation strategies and design.
Participates in pre and post implementation audits of provider configuration, claims processing and payment, benefit coding, member and provider inquiries, enrollment & billing transactions and the corrective action plan process.
Audits multiple lines of business, multiple functions, and multiple systems.
Trend audit results and perform data analysis on trends to determine/recommend adjustments to quality reviews.
Work closely with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops and recommends process improvements and solutions.
Manage process improvement processes; May include activities such leading workgroups, facilitating SWAT sessions, drafting new workflow or procedures.
Functions as a subject matter expert for discrepancy review, questions from team and business partners, and interpretation of guidelines and audit process.
Facilitate and lead meetings with business to review audit plan, audit findings and/or recommendations for improvement.
Acts as a mentor to peer auditors, providing training and managing work and projects as necessary.
Facilitate calibration sessions with the business area, support areas, vendors or clients.
Minimum Requirements
Requires a BS/BA; 4-5+ years related experience in provider or pricing configuration or any combination of education and experience, which would provide an equivalent background.
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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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. 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 may contact elevancehealthjobssupport@elevancehealth.com for assistance.
