AmeriHealth Caritas Supervisor Quality Auditing in Philadelphia, Pennsylvania

Supervisor Quality Auditing

Location: Philadelphia, PA

Telecommuter?: No

ID**: 16228

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 Philadelphia, 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 .

Responsibilities:

Oversee the daily operations of the Quality Auditing team by directly supervising their activities and providing feedback/coaching to the auditors regarding production and quality of the claim auditing completed by the department. The Supervisor will coordinate and monitor all of the audits that are completed in the department – performance management claim audits for the Operations team, all of the pre-disbursement claim audits completed daily, the stratified plan audits, and all elevated audits completed to support training and Operations. The supervisor will also need to be versed to support the team in its audits of call center operations, provider maintenance and enrollment functions. In addition, the supervisor will facilitate the completion of all claim appeals through all three levels. He/she will serve as the decision maker and support for the first two levels. The supervisor will also coordinate with QA management, the Service Teams, and training to develop, review and report out quality results, trending and recommendations for improvement. The supervisor will need to support the development of automation within all aspects of auditing. He/she will need to demonstrate creativity as we work to develop a “best in class” QA program and continue to meet all required SLAs within the department. The supervisor will also be tasked with identifying key contributors on the team and working with them to assist in their continued professional development.

Education/Experience:

  • 5 to 10 years claims experience.

  • Bachelor’s Degree preferred.

  • In depth claim processing knowledge required

  • Facets knowledge preferred.

  • Computer proficiency in Microsoft Word, PowerPoint, Excel, Access, Project

  • Understanding of call center operations, enrollment and provider maintenance preferred

EOE Minorities/Females/Protected Veterans/Disabled