Title: Claims QA Auditor
Location: Denver, CO
Responsible for Audit the Auditor on both the OPA and Random findings of the original audits. Responsible for the rollup of the findings with follow thru to the various auditors and supervisors of the individuals involved. Responsible for roll up and reporting the monthly Audit the Auditor findings to the QA Managers. Responsible for Claims Training Department duties as assigned by the Training Manager. Maintains and supports a culture of compliance, ethics and integrity. Maintains knowledge of policies and procedures and performs in accordance with the Principles of Responsibilities and applicable regulatory requirements, external laws and accreditation standards. Appropriately reports observed fraud or abuse.
Essential Functions:
- Performs Audit the Auditor on designated percentage of work for each auditor w/ results being forwarded to the auditors manager
- Maintains current and up to date written information on all processes used to perform these audits
- Responsible for Desk Level Procedure and Scooter Communications from origination, updates, review of annual status & verification of folder contents in Rapid Resource, maintaining a log for each
- Maintenance of Training Manager's calendar, P-card, Training Supply orders, Time off requests, IT issues, Meeting room scheduling & other duties as assigned
- In addition to defined technical requirements, accountable for consistently demonstrating service behaviors & principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives
- Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior & culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors
Qualifications:
Basic Qualifications:
- A minimum of 4 years of experience in advanced auditing procedures of Medical claims processing on all types of group plans & benefit options
- Bachelor's degree preferred
- Position requires demonstrated advanced proficiency in computer applications e.g. Web based training, Microsoft Word, Excel, Power Point, Business Objects, Crystal, CADB, Macess EXP Service Forms etc
- Advanced written & verbal communication skills w/ emphasis on teaching & communicating effectively in a group as well as on an individual basis
- Position requires exceptional abilities at positive interactions with all levels of the staff while maintaining confidentiality of information.
Salary Range: $20.61 - $26.29 Hourly
