Quality Assurance Manager - FT Days

Careers With Purpose

Join our not-for-profit organization that has provided over 100 years of housing and services to seniors with a commitment to quality care and service in a Christian environment.

Facility: GSS NE Auburn
Location: Auburn, NE
Address: 1322 U St, Auburn, NE 68305, USA
Shift: Day
Job Schedule: Full time
Weekly Hours: 40.00

Job Summary

Responsible for the implementation and day-to-day performance of process activities related to internal audit functions of the organization's health plans. These processes include the audit of system configuration for providers to include contracts and fee schedules, new and renewal group setup, and benefit plans against source documentation and claim payments. Accountable and is a resource to all employees within the audit department and all other departments within the organization. Will provide input in the operations budget discussions. Provide technical or subject matter expertise concerning policies and procedures. Identify areas of operational efficiencies and make recommendations to improve. Develop internal audit processes. Review claims adjustments to identify training/education opportunities and business improvements. Reviews all large dollar claims prior to payment run to insure correct payment. Performs focused review on complex problem areas.

Broad knowledge of medical codes including current procedural terminology (CPT), international classification of diseases (ICD-9) and (ICD-10) and healthcare common procedure coding system (HCPCS). Broad knowledge of medical terminology. Knowledge of all areas of claims processing. Knowledge of vendor contracts, and benefit configuration. Competency in Microsoft Applications (Excel, Access, Word and Outlook). Excellent written and oral communication skills. Ability to work with all other internal departments in a positive manner, work independently, organize and prioritize tasks effectively, multitask, work in fast paced environment and handing stressful situations. Proficient in Tapestry applications; Sanford Health Plan (SHP) policies and procedures; Federal Government and State Insurance regulations.

Qualifications

Bachelor's degree preferred.

Minimum of three years of work experience utilizing auditing techniques.

Benefits

The Good Samaritan Society offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit ~~~ .

The Good Samaritan Society is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call ~~~ or send an email to ~~~ .

The Good Samaritan Society has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0210562
Job Function: Quality and Risk Management
Featured: No