Quality Audit Associate Specialist - Corewell Health : Job Details

Job Summary

The position performs regular audits designed to validate accuracy of information that is maintained by the department. The audits performed also validates those processes are performing in accordance with corporate and departmental policy and procedure. The associate level will have an aptitude to learn technology platforms such as Facets and OnBase. Responsible of routine inspection of at least two audit types (ie. Enrollment & Claims OR Claims and Product). This position ensures that all quality check procedures in the official quality program are followed during the inspection process. The associate level can demonstrate proficiency in performing the function as to what they audit such as Enrollments, Claims, Coding, Product, Coding or Processing across all funding and lines of business. (Fully-funded, ASO, Medicaid, Medicare, Individual plans)

Essential Functions

+ Performs audits according to department policies and procedures. Maintains and utilizes tools needed to track, trend and report audit results per department policy and procedure.

+ Record results in an accurate and organized manner for the purpose of reporting individual and departmental results.

+ Able to collaborate and explain/demonstrate the findings through the audit

+ Looks for opportunities to learn from more experienced Business Systems Analysts.

+ Confers with Quality staff and trainers to gain knowledge of work situations requiring training for employees to better understand changes in policies, procedures as well as changes in the Certificate of Coverage and Schedule of Benefits for various plans. May initiate procedure changes.

+ Works under close supervision within established policies, practices and guidelines.

+ Actively seeks to keep informed and updated on all software systems.

How Corewell Health cares for you

+ Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here ( .

+ On-demand pay program powered by Payactiv

+ Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

+ Optional identity theft protection, home and auto insurance, pet insurance

+ Traditional and Roth retirement options with service contribution and match savings

Qualifications

Required

+ Associate's Degree /Technical school or equivalent

+ 1 year of claims examiner experience

Preferred

+ Bachelor's Degree or equivalent

+ 2 years of relevant experience Managed care experience.

+ Experience with FACETS

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

PH - Operations Development and Quality

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. - 5:00 p.m.

Days Worked

Monday - Friday

Weekend Frequency

N/A

CURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.###.####.