Top 4 Quality auditor Jobs in Fall River, Ma

Claims Quality Control Auditor
Neighborhood Health Plan of Rhode Island —Smithfield, RI
- Full-time
- Microsoft Outlook
- Basic math
- Research
Quick Apply
4d
Quality Process Auditor - 2nd Shift
Taco Family of Companies —Cranston, RI
- Full-time
- ERP systems
- Office
- Residential
- Tuition reimbursement
Quick Apply
Materials Testing Auditor - Independent Contractor
Performance Review Institute —United States
- Part-time
- 7 years
- Bachelor of Science
- Senior level
- Flexible schedule
- Referral program
Quick Apply

More jobs to discover

Find similar jobs that you might be interested in.

Quality Process Auditor - 2nd Shift
Taco Family of Companies —Cranston, RI
Associate degree in Industrial Technology or related field. They monitor the machining, assembly and testing operations to assure that the products comply to…
Quick Apply

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

QA / QC Auditor
The Davey Tree Expert Company —Ohio
*Driver's License:* Valid driver’s license with a clean driving record. This *entry-level position* is an individual contributor role working in a *field…
$22 - $24 an hour
Quick Apply
2d
Quality Auditor - 1st Shift
Ace Hardware —West Jefferson, OH
Data Collection & Reporting • Use systems like: o WMS (Warehouse Management System) o Excel or audit tracking tools • Document: o Audit results o Defects and…
$20.50 an hour

Show more jobs in cities nearby

I want to receive the latest job alert for quality auditor in fall river, ma

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

quality auditor jobs near fall river, ma

Quality Auditor jobs in Cranston, RI

Nurse Auditor jobs in Florida

Auditor jobs in Wichita, KS

Auditor No Degree jobs in Remote

Food Safety Auditor jobs in California

Quality Auditor jobs in Nebraska

Quality Auditor jobs in Bloomfield, CT

Quality Auditor jobs in Kennesaw, GA

Quality Assurance Remote jobs in Chicago, IL

Night Auditor jobs in Jacksonville, FL

Senior Internal Auditor jobs in Chicago, IL

Quality Auditor jobs in Baytown, TX

Quality Auditor jobs in West Memphis, AR

Quality Auditor jobs in Austin, TX

Auditor jobs in Maryland

Quality Auditor jobs in Florida

Quality Engineer jobs in Oklahoma City, OK

Quality Auditor jobs in Remote

Claims Quality Control Auditor

Neighborhood Health Plan of Rhode Island -
Smithfield, RI

Quick Apply

Job Details

Full-time
4 days ago

Qualifications

Contract documentation review
Contract review
Microsoft Outlook
Spreadsheets
Basic math
Contract interpretation
Data analytics technologies

Full Job Description

The Claims Quality Control Auditor ensures organizational claim processing complies with contractual and regulatory requirements. The position performs audit functions for “internal and external” clients, provides training standards based on findings; creates statistical auditing reports for management; identifies trends and potential issues with claims processing, and recommends process improvements to maximize accuracy.

Duties and Responsibilities

Responsibilities include, but are not limited to the following:

Review Neighborhood’s claim process functions, including auto adjudicated and manually processed claims and issues, based on provider and health plan contractual agreements and claims processing guidelines.
Adhere to internal processes/procedures that ensure claim auditing functions comply with company policies and procedure standards.
Identify trends and patterns in errors and issues found during audit reviews and upchannel to appropriate management.
Prepare written reports on audit findings, scores and corrective actions.
Advise and assist external departments with claims research and processing issues.
Identify root cause for claim errors, and collaborate with internal and external departments to develop and implement solutions for resolution of identified issue
Review post impact analyses provided by Operations Support to ensure systems upgrades have been configured accurately. Provide written report to Business Analysts of review results. Review any problems found with appropriate Business Analyst.
Create Master Impact Analysis (IA) for each processing system. This Master IA will be created from results of the weekly Claims Adjustment Committee meeting and be used by adjusters from each delegate to reprocess claims according to the respective configuration changes in each system.
Participate in User Acceptance Testing (UAT). As such, perform analysis and review all upgrade information to ensure accuracy and completeness negating any future claims processing issues. Identify any errors in claims processing during this testing and provide input to the configuration teams involved.
Complete any ad-hoc audits that approved by Claims management that are requested by upper management, legal, contracting, or any other party within Neighborhood.
Identify and communicate ways to improve claims and systems processing accuracy and increase provider/member satisfaction.
Report claims with suspected fraud, waste and abuse to management, and submits referrals to Special Investigation Unit.
Other duties as assigned

Qualifications

Required:

Associates Degree or equivalent relevant work experience in lieu of a degree
Minimum 1-3 years directly related experience in medical billing or claim processing
Capable of performing mathematical functions (i.e., calculations/discounts/interest commission/percentages, etc.)
Intermediate to Advanced skills in Microsoft Office Suite (Excel, Outlook, Word)
Data analytics experience
Ability to read understand and apply contract terms to claims processing and quality audits
Excellent communications skills allowing for the effective description of systems deficiencies and processing errors
Ability to work both independently and in a team-based environment
Ability to manage multiple projects simultaneously
Must exercise excellent judgment and be effective working autonomously and as part of a team
Exceptional listening skills and verbal/written communication skills
Problem solver with strong attention to detail

Preferred:

Certified Professional Coder (CPC) certification
3+ years directly related experience in medical billing or claim processing
Knowledge of COGNOS reporting environment
Prior experience with Optum Encoder or similar coding program/websites

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Quick Apply

Refine Your Search

quality auditor jobs in fall river, ma

Claims Quality Control Auditor

Quality Process Auditor - 2nd Shift

Materials Testing Auditor - Independent Contractor

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for quality auditor in fall river, ma

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected