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Quality Assurance Auditor, Senior, Medicare/Medi-Cal

Company: Blue Shield of California
Location: Woodland Hills
Posted on: February 24, 2021

Job Description:

Quality Assurance Auditor, Senior, Medicare/Medi-Cal Quality Assurance Auditor - Responsible for performing production and quality control audits to measure performance. Assures adherence to established specifications and quality standards. Conducts comprehensive quality review to identify performance deficiencies. May use quality analysis tools to analyze trends, root causes and identify systemic corrective action opportunities. Creates management reporting for review and follow up.

Responsibilities

  • Responsible for performing or leading audits.
  • Exercises independent judgment and initiative in resolving complex and non-recurring problems. Responsible for accessing documentation from all lines of business and internal and external sources.
  • Validates findings of lower level employees. Identifies areas for improvement in upstream/downstream processes and areas of interfacing based on acquired knowledge and recommends improvements. Participates in corrective/preventive action planning/implementation related to audits.
  • Other duties as assigned. Organizational Impact
    • Works to achieve operational targets with direct impact on departmental results.
    • Works independently under limited supervision.
    • Work is reviewed for adequacy in meeting objectives.
    • May be responsible for entire projects or processes within job area. Innovation and Complexity
      • Responsible for improving processes, systems or products to enhance performance of the job area.
      • Problems and issues faced are difficult and may require understanding of broader set of issues. Problems typically involve consideration of multiple issues, job areas or specialties, and are typically solved through drawing from prior experience and analysis of issues.
      • Develops new perspectives and approaches on existing problems . Communication and Influence
        • Communicates with parties within and outside of own department, with the ability to educate others on complex disciplines.
        • May have responsibility for communicating with parties' external to the organization (e.g., customers, vendors, etc.).
        • Works to influence parties within and outside of the job function at an operational level regarding policies, practices and procedures. Leadership and Talent Management
          • May be responsible for providing guidance, coaching and training to other employees within job area.
          • May manage projects requiring the responsibility of delegating work and reviewing resulting work product. Knowledge and Experience
            • Prior audit experience in Medicare and/or Medi-Cal required.
            • Hours of operation may include some weekends.
            • Strong analytical and problem-solving skills.
            • CMS/DMHC Regulatory knowledge preferred.
            • Proficiency in Excel and PPT required.
            • Experience with Verint is a plus.
            • Typically, requires advanced knowledge of job area typically obtained through advanced education combined with experience. May have practical knowledge of project management.
            • Typically, requires a college degree or equivalent experience and minimum 5 years of prior relevant experience. Additional Information
              • About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!
              • EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
              • Requisition ID: 210016F
              • Posting Date: Feb 17, 2021
              • Schedule: Full-time My Profile Create and manage profiles for future opportunities. --- Woodland Hills, California, United States of America --- Woodland Hills, California, United States of America If you have a disability and need assistance applying for a position with Blue Shield of California, call RehabWest, Inc. at (760)759-7500.

Keywords: Blue Shield of California, Los Angeles , Quality Assurance Auditor, Senior, Medicare/Medi-Cal, Accounting, Auditing , Woodland Hills, California

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