Operations Quality Auditor – Philadelphia, PA Position Available In Allegheny, Pennsylvania

• 449469BR
• Auto req

ID:

• 449469BR

• Company:

• AmeriHealth Caritas

• Job Code:

• OperationsManager Operations Manager

• Job Description:

• On behalf of VetJobs/MilitarySpouseJobs, thank you for your interest.

We are assisting our partnering company, listed below, with this position. It is open to Veterans, Transitioning Military, National Guard Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow for next steps. Under the direct supervision of the Supervisor, Manager, and/or Director of Operations Quality Auditing, the Operations Quality Auditor is responsible for the timely and accurate review of various tasks performed by Operations (including, but not limited to, claims processing, call handling, and member/provider data maintenance).

Responsibilities:

Identifies system and/or operational issues hindering the attainment of quality performance standards as defined by AMFC policy and associated business rules Provides issue identification, problem analysis, and strategies for resolution and/or implementation to Management Accurately documents audit findings in the appropriate quality tool

Education and Experience:

High School/GED required Minimum 3 years’ claims experience in a Medicaid environment Claims processing knowledge required, preferably with the Facets system Working knowledge of Microsoft Office applications Experience in call center operations and member/provider database maintenance preferred Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you. Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

• Position Title:

• Operations Quality Auditor – Philadelphia, PA

• Job Category:

• Operations

• Minimum Education Required:

• High School/GED
• City
• :•Pittsburgh •State•:•Pennsylvania