Quality Auditor - Provider Relations

Texas Children's Hospital • Houston, TX

1d

About The Position

We are searching for a Quality Auditor-- someone who works well in a fast-paced
setting. In this position, you will be responsible for reviewing and evaluating
the quality and effectiveness of the department policies and procedures,
processes, and system updates such as member eligibility, provider setup,
benefit/contract/edit configuration, and/or code/rate updates. This role will
partner with the department managers on audit findings to ensure identified
errors are promptly and appropriately corrected, as well as identified
performance and/or training gaps are addressed. The Quality Audit also tracks
and reports quality metrics for the department and serves as the department's
point of contact for audit inquiries.

Think you’ve got what it takes?

Requirements

• High school diploma or GED required
• 2 years Medicaid Managed Care experience required
• 4 years health plan operations experience required
• 4 years health plan payer systems/applications experience required

Nice To Haves

• Bachelor’s degree in healthcare administration, business administration, computer science or related field preferred
• 2 years auditing/quality/review/training experience preferred

Responsibilities

• Review and evaluate the quality, accuracy, and timeliness of system updates such as member eligibility, provider setup, benefit/contract/edit configuration, and/or code/rate updates
• Create a tracking and reporting mechanism for audits to be able to share findings with the department managers and assist with identifying performance and training gaps
• Develop and track quality metrics for the department that are reported to leadership on a routine basis and incorporated into the departmental dashboard
• Identify and report process improvement opportunities for the department to increase efficiencies, performance, and quality
• Assist with the production of various reports regarding the department’s quality and performance
• Develop and maintain policies and procedures for the departmental audit program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED