Job Title: Certified Coding Specialist
Location: Remote Job
Duration: 3 Months with possible contract to hire
Description:
Purpose:
The Quality Assurance Specialist III is an advanced-level auditor position performing in-depth system and procedural audits. This role conducts regular reviews and audits of internal controls within each functional area for strengths and weaknesses ensuring special focus to the specific risk areas. The incumbent is considered a Subject Matter Expert (SME) in their audit field and provides a comprehensive analysis of transaction, systems and procedures.
Essential functions:
50% Audits assigned function (service, claims, enrollment) for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Identifies, documents and reports transaction errors utilizing departmental quality monitoring templates in a timely manner to ensure prompt resolution
20% Assists in development of special department projects and participates in department and divisional projects
20% Conducts structured coaching and feedback sessions. Provides suggestions and creates improvement plans for areas of deficiency within the group or for an individual
10% Participates in the creation and implementation of new methods, processes and/or products
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Experience:
5 years Auditing, Quality Assurance, Operations, Training, Project Management or comparable work experience
2 years experience as Quality Assurance Specialist II
Preferred qualifications
Knowledge, Skills and Abilities (KSAs)
Knowledge of quality assurance and production technologies., Expert
Proficient in Microsoft Office programs., Proficient
Extensive of industry standards, quality control techniques and procedures., Advanced
Excellent communication skills both written and verbal., Advanced
Extensive analytical and problem solving skills, Advanced
Strong interpersonal skills, Advanced
Excellent research and organizational skills, Advanced
Licenses/certifications
ECA Certified Quality Assurance Manager
Additional skills:
Coding certification (CPC or COC, CPMA et., Claims and insurance experience. Medical records auditing
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