What are the responsibilities and job description for the Quality Assurance Specialist position at GEHA?
GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees.
GEHA has one mission: To empower federal workers to be healthy and well.
Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization.
The Quality Assurance Specialist audits claims coding, customer service calls or electronic files for accuracy, benefit payment, contract interpretation, and compliance with policies and procedures.
SKILLS
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.
REQUIREMENTS:
- Requires an associate's degree. Will consider additional experience in lieu of degree.
- Requires 4 years of related experience.
- Requires effective written and verbal communication skills to answer questions from staff and providers.
- Requires proficiency with MS Word and MS Excel.
- Must have thorough knowledge of Provider Data Management policy and procedures.
PREFERRED:
- Experience as an Associate Quality Assurance Specialist within PDM
Work-at-home requirements
- Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
- A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
- Latency (ping) response time lower than 80 ms
- Hotspots, satellite and wireless internet service is NOT allowed for this role.
- A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
How we value you
- Competitive pay/salary ranges
- Incentive plan
- Health/Vision/Dental benefits effective day one
- 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
- Robust employee well-being program
- Paid Time Off
- Personal Community Enrichment Time
- Company-provided Basic Life and AD&D
- Company-provided Short-Term & Long-Term Disability
- Tuition Assistance Program
Please note that the salary information is a general guideline only. GEHA considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.
The annual base salary range for this position is $44,870 - $63,250 USD.
GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. Our diversity drives innovation deepens connections and strengthens our organization.
GEHA is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.
Salary : $44,870 - $63,250
