Summary
The Quality Assurance Specialist audits claim coding, customer service calls or electronic files for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures.
Duties
- Updates and completes daily, monthly and annual reports.
- Prepares responses to correspondence and handles complex provider issues and calls.
- Answers questions from PDM staff and other departments regarding provider updates and issues.
- Makes recommendations to improve quality, workflow processes, policies and procedures.
- Assists with department training.
- Contributes independently and collaboratively across departments and cross-functional projects.
- Analyzes audit reports and rebuttals to identify trends and recommend determination of outcome.
- Reviews and makes suggestions for changes/updates to training materials and existing desk level procedures and policies.
Education Requirements
Requires an associate's degree. Will consider additional experience in lieu of degree.
Experience Requirements
- Requires 4 years of related experience.
- Requires effective written and verbal communication skills to answer questions from staff and providers.
- Requires proficiency with MS Word and MS Excel.
- Must have thorough knowledge of Provider Data Management policy and procedures.
Preferred
- Experience as an Associate Quality Assurance Specialist within Provider Relations department.
- Candidate must reside in MO or KS
GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. We celebrate diversity and are committed to creating an inclusive environment for all employees.
