Health Plan Auditor I – REMOTE Position Available In Fulton, Georgia

Job Description:

The Auditor is a contributor to the Audits department’s workthat spans the broad spectrum of healthcare performance measurementprojects at HSAG. Driven by intellectual curiosity and a passionfor healthcare quality, this position performs-undersupervision-healthcare auditing, data validation, and performancemeasurement projects through various stages includingimplementation, day-to-day operations, audit support, evaluation,and reporting. Activities include developing work plans andtimelines; overseeing project tasks; guiding coordination staff inoversight and maintenance of project files; leading clientteleconferences and meetings; performing online research onhealthcare topics; leading primary source verification; validatingperformance results and outcomes; and providing regular progressreports to Data Science & Advanced Analytics management staff.

Details regarding potential project assignments will be discussedwith potential candidates during the interview process. EssentialCompetencies, Duties and Responsibilities Serve as a contributingmember of HSAG’s Audits department within DSAA. Act in a liaisoncapacity between appropriate management personnel and staff,transmitting decisions and information to organizational units asappropriate, as well as outside agencies and organizations, undersupervision. Lead project management tasks, including communication(written, phone, fax), under supervision. Communicate with projectpartners, consultants, subcontractors, and other entities on auditand performance measure validation-related projects, undersupervision. Maintain, tag, and sort documents for assignedprojects on appropriate SharePoint team sites and HSAG’s corporateand federal networks following HSAG prescribed governance rules.

Prepare project deliverables and lead documentation and submissionof deliverable using the appropriate mechanism (i.e., electronic,hard copy, direct data entry etc.), under supervision. Develop andadhere to project time and task schedules, identify opportunitiesto improve the project process, and develop quality improvementactivities accordingly. Meet agreed-upon deadlines in a timelyfashion and accurately prepare and type deliverables, reports,various project documents, letters, and other material from copy,rough draft, or other prescribed instructions. Support developmentof written and data-oriented reports in Microsoft Word and Excel,under supervision. Conduct research via the Internet includingliterature searches of clinical topics as assigned. Participate inpertinent healthcare educational and training presentations asrequired. Conduct Internal Quality Control (IQC) monitoringregarding efficiency/effectiveness of activities conducted. Presentissues and recommended solutions and take corrective actions asindicated. Serve as a reference to HSAG staff and clients onHealthcare Effectiveness Data and Information Set (HEDIS®) [1]measures and non-HEDIS performance measures as applicable.

Represent HSAG in a professional manner at all times. [1] HEDISCertified Measures® is a registered trademark of the NationalCommittee for Quality Assurance (NCQA). Education and/or ExperienceBachelor’s degree in business, science, or healthcare-relatedfield. At least one year of work experience in healthcare isrequired; two years of work experience in healthcare is preferred.

At least one year of auditing experience is required. OtherQualifications Proficient English/communication skills (i.e.,public speaking, spelling, composition, grammar, proofreading andediting). Proficient interpersonal skills. Experience in MicrosoftWord, PowerPoint, and Outlook. Experience in Microsoft Excel.

Experience in conducting research via the Internet. Ability tohandle several projects simultaneously and work with multipleteams. Work Environment The work environment characteristicsdescribed here are representative of those an employee encounterswhile performing the essential functions of this position.

Reasonable accommodations may be made to enable individuals withdisabilities to perform the essential functions. Disclaimer This isnot necessarily an exhaustive list of all responsibilities, skills,duties, requirements, efforts or working conditions associated withthe position. While this is intended to be an accurate reflectionof the current position, management reserves the right to revisethe position or to require that other or different tasks beperformed when circumstances change (e.g., emergencies, changes inpersonnel, work load, rush jobs requiring non-regular work hours,or technological developments). HSAG is an EEO Employer of Veteransprotected under Section 4212. If you have special needs and requireassistance completing our employment application process, pleasefeel free to contact us. EOE M/F/Vet/Disability