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with the business to provide consultation and advice to management related to policy and procedure identified as out of date or incomplete and investigates, develops and recommends process improvements and solutions.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.
