Location: This is a virtual position, the ideal candidate will live within 50 miles of the Cincinnati, Ohio FHPS office location.
Federal Health Products and Services - FHPS, a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, and the foundation upon which we are creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
The G&A Auditor II is responsible for post completion examination of grievances and appeals in multiple states.
How you will make an impact:
Reviews case to determine applicability of, and compliance with, federal and state regulations, enterprise policies and procedures and all related accreditation standards.
Reviews case to assess whether it was appropriately handled as a clinical or administrative request and was correctly processed to avoid prompt pay penalties.
Evaluates urgency of clinical situation to assess appropriate handling, determine if sufficient records were obtained, and review medical records and medical policies to determine if correct criterion has been utilized in each review.
Reviews case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation.
Assists management in process improvement strategies to achieve business objectives.
Prepares audit findings and recommendations for G&A associates and management on a monthly basis.
Identifies and communicates error trends to improve overall quality of enterprise G&A team.
Associates at this level handle routine to complex audits and function as subject matter experts.
Minimum Requirements:
Requires a BA/BS degree, a minimum of 2 years of grievance and appeals experience; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
FHPS claims and customer service experience is preferred.
FHPS requirements, processes and systems knowledge preferred.
Excellent oral and written communications skills.
Exceptional organization and time management skills.
