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Claims Quality Control Auditor II in Woburn, MA at Beacon Health Options

Date Posted: 11/26/2018

Job Snapshot

Job Description

About The Position:

The Claims Quality Control Auditor II will work under the direction of the Supervisor/ Manager of Claims Quality Control and will be responsible for supporting quality initiatives through a variety of auditing activities including the End to End Audit process. The person hired in this role will contribute in the identification of opportunities to improve work processes and collaborate in the development of solutions to problems found in the work that is reviewed. This is a key role in the successful operations of claims processing, provider network setup and system configuration.

Position Responsibilities:

  • Review claims on an end to end basis including provider setup, contract review, plan setup and configuration
  • Serve as a liaison to Account Management for appropriate plan records, sign off, and reporting
  • Track and report on findings and remediation
  • Ability to present information in an organized professional manner during external audits
  • Consistent and methodical review according to established guidelines
  • Meet all deadlines (weekly/monthly/quarterly) for review of work
  • Clearly state what is identified as a deficiency or error in work being reviewed
  • Work proactively with the Supervisor of Claims Quality Control to ensure quality recommendations are made and implemented 
  • Maintain thorough and complete knowledge of assigned functional processes to effectively evaluate accuracy levels 
  • Ensure timely and accurate quality data is reported
  • Research and assist to define regulatory or accreditation requirements as needed
  • Other Duties as assigned

Position Requirements:

  • Education: Bachelors preferred
  • Licenses: Certification in auditing, or certification/licensure related to the functional areas being audited would be beneficial
  • Relevant Work Experience: Minimum of 2 years’ experience in a Managed Healthcare setting (with a strong understanding or Managed Healthcare operations, background in behavioral health would be beneficial)

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled