Senior Appeals Quality Auditor - Remote Nationwide, Bonus Eligible
Company: Centene Corporation
Posted on: November 22, 2021
*Applicants for this job have flexibility to work from home
anywhere in the United States. This job is eligible for a $3,000
You could be the one who changes everything for our 25 million
members. Centene is transforming the health of our communities, one
person at a time. As a diversified, multi-national organization,
you 'll have access to competitive benefits including a fresh
perspective on workplace flexibility.
Position Purpose :
Performs complex and routine quality audits in Appeals for one of
the following teams; par provider, non-par provider and/ or members
using databases and a prescriptive audit tool to verify the
completeness, accuracy and adherence to regulations, departmental
procedures and documentation guidelines of randomly selected appeal
files. Documents and reports findings by individuals and teams.
Provides feedback and recommends improvements within the
department. When indicated, gives one-on-one training in response
to unfavorable audit scores.
Assists Quality Auditors with questions, casework, and complex
Conducts complex and routine quality reviews of staff level
Tracks and maintains quality results for appropriate
Communicates audit results in a structured report format.
Coaches and gives feedback to quality auditors and coordinators
based on error findings.
Facilitates individual training regarding the competencies needed
based on audit results.
Maintains audit tools consistent with regulatory guidelines.
Creates new audit tools as warranted by business growth.
Assists in identifying and communicating process improvement
opportunities across Appeals based on quality audit reviews.
Supports management staff with internal and external audit
Proofs regulatory reporting for data accuracy.
Serves as plan contact/touch point for Maximus and/or other
external auditors as needed.
Assists with special projects and other duties as assigned.
Assists in auditing activities for NCQA, URAC and other
Represents Appeals department at meetings where metrics are
Performs other duties as assigned.
Our Comprehensive Benefits Package :
Flexible work solutions including remote options, hybrid work
schedules and dress flexibility
Paid Time Off including paid holidays
Health insurance coverage for you and dependents
401(k) and stock purchase plans
Tuition reimbursement and best-in-class training and
High School Diploma or GED required; Associate's Degree in a
related field preferred
5+ years of experience in -a Claims, Customer Service or healthcare
3+ years of experience in appeals or grievances
Centene is proud to offer competitive benefits for this position.
-They are available for review at:
Centene is an equal opportunity employer that is committed to
diversity, and values the ways in which we are different. All
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, sexual orientation,
gender identity, national origin, disability, veteran status, or
other characteristic protected by applicable law.
Keywords: Centene Corporation, Savannah , Senior Appeals Quality Auditor - Remote Nationwide, Bonus Eligible, Other , Bluffton, Georgia
Didn't find what you're looking for? Search again!