Important things YOU should know :
- Schedule : Monday - Friday 7 : 30am-4 : 30pm with an opportunity to flex
- Fully remote role
What will YOU be doing for us? Provide guidance and leadership to Claims Audit team members to ensure accurate and timely completion of TPA comprehensive claims related audits and refund research.
What will YOU be working on?
Represent Audit team as a decision maker and subject matter expert in client and internal meetings impacting Claims Audit.Collaborate with other department leadership to proactively identify and communicate potential issues to ensure Quality performance.Lead continuous improvement efforts and understand how workflow decisions will impact the department.Develop, implement and own a comprehensive Audit Program that includes the validation of processing accuracy throughout the claims cycle to include outputDrive best practices within the team and develop a monitoring and feedback mechanism to ensure team member compliance with newly adopted audit criteriaIdentify process efficiencies to minimize or eliminate manual intervention or duplicative efforts.Lead efforts to identify and implement process improvement opportunities using change management tools and techniques that ensure a clear understanding and value that change brings to the company and clients.Oversight of the creation, review and updating of documentation supporting all audit related processes.Prepare and present audit findings, trends and results as needed in various forums and levels of audience.Collaborate with other TPA business leaders to determine root cause and remediation of errors or issues identified during the course of an audit.Seek insight from other leaders on potential areas or factors that are at higher risk for error. As appropriate, facilitate changes to the audit process to ensure those risks are accounted for.Conduct one-on-ones with all team members to provide feedback on performance, seek to understand any challenges that they may be experiencing, provide guidance and mentoring to increase individual and team performance, ensure communications and messaging from others is reviewed and understood (i.e. corporate messaging, survey results, etc. )Actively engage in and take action on feedback received from other SKYGEN teams specific to the audit process, individual or team performance and surveys that are conducted.Facilitate review and approval of timecard and PTO requests, ensuring adequate coverage.Oversight of daily work management, to include but not limited to : claims audits, focused audits, system follow ups, return / refund checks, and tickets assigned to Audit via ticketing system to ensure all are completed in timeframes compliant with state, federal and other client agreement requirements.Review individual / team production and accuracy results to ensure compliance with department, client and regulatory guidelines and standards.Evaluate employee and team performance to identify training and development needs.Collaborate with leadership to develop, maintain and facilitate training programs and materials to ensure staff is appropriately trained to successfully perform their roles.Proactively communicate updates and changes to audit assignments, SLAs and reference materials in a timely manner.Facilitate quick and accurate issue resolution by developing and maintaining collaborative working relationships with internal departments.Participate in client audits and provide thorough documentation and research as needed.Develop and motivate staff. Initiate and communicate a variety of personnel actions including status changes, performance and compensation reviews, performance improvement and development plans.Additional Job Responsibilities :
Participate in various internal committees dedicated to quality, process improvement, and other organization wide initiatives.Participate in various cross departmental special projects designed to increase client and member satisfaction.What qualifications do YOU need to have to be GOOD candidate?
Required Level of Education, Licenses, and / or CertificatesHigh school diploma or equivalent
Required Level of Experience2 years of leadership experience
2 years of experience in audit or related fieldRequired Knowledge, Skills, and AbilitiesExcellent communication skills
Ability to motivate team to enhance audit process, research skills / techniques and adapt to changeAbility to organize work appropriately to meet deadlinesAbility to utilize resources to solve problems independentlyDemonstrated ability to make appropriate decisions when faced with conflicting deadlines or needsDemonstrated use of Microsoft Office products (Word, Excel, and PowerPoint)What qualifications do YOU need to have to be GREAT candidate?
Preferred Level of Education, License, and / or CertificatesAssociates or Bachelor's degree in Healthcare Administration or related field
Preferred Level of ExperienceExperience with dental, medical and vision terminology, anatomy and physiology
3 years of leadership experiencePreferred Knowledge, Skills, and AbilitiesDemonstrated experience to influence internal and external customers without direct authority
Knowledge of Enterprise System and interrelation of modulesKnowledge of medical, dental and vision claims payment and billing processesSequel (SQL) script development and executionThe salary range and midpoint is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.
Compensation Range :
62,422.00 - $93,634.00
Compensation Midpoint :
78,028.00
Salary : $78,028
