Performance Auditor Jefferson Health Plan
Share
Job Location:
Philadelphia, PA - USA
Monthly Salary:
Not Disclosed
Posted on:
11 days ago
Vacancies:
1 Vacancy
Job Summary
Job Details
Under the general direction of the Manager Performance Audit the Performance Auditor is responsible for the completion of Quality Audits / Reviews within the Health Partners Plans Organization. This particular position will plan and conduct operational audits to support the Enrollment department. The Performance Auditor is expected to have experience and demonstrate proficiency in performing quality assurance audits/reviews which conform to professional audit standards. The Performance Auditor will assist the Sr. Performance Auditor with planning development of audit programs for audit testing and evaluation and reporting of audit results. The complexity and size of audit assignments varies.Job Description
- Executes a wide variety of audit tests/procedures and accurately interprets results against defined criteria.
- Understands the operational and compliance risks that affect HPPs Operations; demonstrates the ability to identify and appropriately measure those risks; and formulates recommendations that are appropriate practical and cost-effective.
- Consistently documents relevant facts and information to support the work performed and conclusions drawn so operations representatives can follow the auditors logic and methodology.
- Effectively evaluates audit results weighing the relevancy accuracy and perspective of conclusions against the accumulated audit evidence.
- Effectively communicates audit results both verbally and in writing so they are clear and concise placed in the appropriate context and understood by the recipient.
- Conducts audits in accordance with professional and departmental standards.
- Knows when to seek guidance from supervising staff as circumstances warrant.
- Completes work assignments independently or as part of a team project.
- Interacts effectively with others in a professional manner.
- Demonstrates effective time management skills by completing assignments within assigned timeframes.
- Exhibits creativity and innovation in recommending improvements to departmental audit practices and processes.
Education and Experience:
- Associates Degree from an accredited university / college in a relevant course of study or
- High School Diploma/GED in the absence of college coursework at least two years in managed care or health insurance customer service audit or quality assurance experience with a minimum of 4 years proficiency in a health insurance operational function will be considered
- Working knowledge of current Applications and Core Systems that support the Enrollment business unit.
- Outstanding analytical interpersonal and written communication skills.
- Ability to communicate effectively.
- Medical Terminology
- working knowledge of HIPAA and other related regulations
- MS Office skills.
Work Shift
Workday Day (United States of America)Worker Sub Type
RegularEmployee Entity
Health Partners Plans Inc.Primary Location Address
1101 Market Philadelphia Pennsylvania United States of AmericaNationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.
Benefits
Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues including medical (including prescription) supplemental insurance dental vision life and AD&D insurance short- and long-term disability flexible spending accounts retirement plans tuition assistance as well as voluntary benefits which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues including those who work less than part-time(including per diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.
For more benefits information please click here
Required Experience:
IC
Key Skills
- Auditing
- Time Management
- ICD-10
- Accounting
- Component evaluation
- Workers' Compensation Law
- SOX
- Microsoft Excel
- CPT Coding
- Internal Audits
- Medicare
- Bookkeeping
About Company
At Thomas Jefferson University in Philadelphia, PA, we are helping you to redefine what’s possible with innovative and tailored education opportunities.
