What are the responsibilities and job description for the Quality Assurance Specialist position at GEHA, Inc.?
Summary
The Quality Assurance Specialist audits claim coding, customer service calls or electronic files for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures.
Duties
- Updates and completes daily, monthly and annual reports.
- Prepares responses to correspondence and handles complex provider issues and calls.
- Answers questions from PDM staff and other departments regarding provider updates and issues.
- Makes recommendations to improve quality, workflow processes, policies and procedures.
- Assists with department training.
- Contributes independently and collaboratively across departments and cross-functional projects.
- Analyzes audit reports and rebuttals to identify trends and recommend determination of outcome.
- Reviews and makes suggestions for changes / updates to training materials and existing desk level procedures and policies.
