Elevance Health Performance Quality Auditor Lead in Richmond, Virginia
Performance Quality Auditor Lead
Job Family: Customer Care
Type: Full time
Date Posted:May 10, 2023
Req #: JR69312
MO, ST LOUIS
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
Performance Quality Auditor Lead
Location: Hybrid, 0-3 times a month/in office. Must reside within 50 miles of a Pulse Point location.
The Performance Quality Auditor Lead is responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries.
How you will make an impact:
Functions as subject matter expert for multiple types of audits, ensuring the implementation and execution of audits, monitoring adherence to the prescribed audit methodologies and documentation, and completing analysis and trending of audit results.
Interacts regularly with business and vendor partners, presenting contractual and audit program results, reviewing discrepancies and validating implementation of action plans, managing appeals processes, identifying process improvement opportunities, and performing calibration sessions for various audit scenarios.
Acts as a leader for the team, providing training and guidance for audit staff, answering questions from the staff around the audit process or multiple system questions that may arise, and filling in with managerial duties as required.
Assists with managing audit workload and ensures operating efficiency for the audit process.
- Requires a BA/BS degree and a minimum of 5 years of experience including at least 3 years of progressively responsible audit experience, leadership experience or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
Proficiency in Excel strongly preferred
PTCB tech license ( CPhT) strongly preferred
Experience in Pharmacy or Prior Authorizations for medications preferred.
Basic understanding of statistics and thorough understanding of different audit methodologies strongly preferred. In-depth knowledge of multiple systems and proven understanding of processing principles, techniques and guidelines and excellent organizational, project management, analytical, leadership, verbal and written communication skills strongly preferred.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $62,400 to $112,320
Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
- The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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.
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 – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 email@example.com for assistance.
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