Quality Assurance Analyst

Company : Highmark Inc.Job Description : JOB SUMMARY This job performs transactional non-clinical quality audits and tasks in compliance with all regulatory compliance guidelines, UM Contracted Clients as well as contractual Performance Guarantees and other operational quality process improvement efforts. Maintains accurate audit documentation and is required to follow appropriate audit guidelines as well as department and Corporate policies and procedures. ESSENTIAL RESPONSIBILITIES Perform a complete review and analysis of transactions as required by all regulatory compliance guidelines, UM Contracted Clients as well as contractual Performance Guarantees and other operational quality efforts to determine accuracy and compliance with guidelines and contractual obligations. Possess a thorough understanding of operational procedures and systems within the process being audited. Manage individual inventory of audit work to meet department quality standards. Participate in special project work as needed. Effectively utilize audit tool to manage audit case inventory, document audit samples and describe and support audit findings and communicate them to internal and external customers as appropriate. Obtaining source documentation, validating it is accurate and complete in compliance with guidelines and reporting requirements. Maintain scorecard entries in audit tool accurately and consistently meet all production standards established in departmental protocol. Monitor various mediums to ensure awareness of most current information available via the Knowledge Center, Compass for UM, and/or other resources to apply to auditing determinations. Share relevant information with the team when received individually through normal work channels. Other duties as assigned. EDUCATION Required High School Diploma/GED Substitutions None Preferred Bachelor's Degree in Business Administration/Management, Accounting, Health Administration or General Studies EXPERIENCE Required (one or more of the following) 3 years in Claims Support and Processing 3 years in Customer Service 3 years in Billing 3 years in Enrollment 3 years in Benefits Administration 3 years in Utilization Management Preferred None LICENSES AND CERTIFICATIONS Required None Preferred None SKILLS Auditing Claims Processing Customer Service Billing Systems Benefit Coding Enrollment Systems Utilization Management Systems Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $23.16 Pay Range Maximum: $35.88 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice Apply To This Job