QA Specialists

The QA Specialists - Billing/ Medical Claims Review is part of the Training & Quality Assurance Department and reports to the Quality Assurance Department Manager. The position is a non-exempt, hourly role and is located at 500 Steed Road, Ridgeland, MS 39157.

GENERAL JOB DUTIES AND RESPONSIBILITIES:

The QA Specialists - Billing/ Medical Claims Review will ensure that the company's quality standards are observed. This person must be a detail-oriented professional, responsible for the development and implementation of inspection activities, the detection and resolution of problems, and the delivery of satisfactory outcomes. They will effectively communicate results with customers, providers, coworkers, and managers. Preferred candidate has TPA experience and previous BITSY utilization. To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Audits internal processes to ensure policies and procedures are followed.
• Completes reports on the findings from quality assurance reviews.
• Assists or suggest department standards and P&P to the QA Manager.
• Provides feedback to the Quality Assurance Manager regarding audit findings within the TPA.
• Performs other duties as assigned by the QA Manager.

EXPERIENCE AND EDUCATION REQUIREMENTS:

• High School Diploma or GED required. Associate or bachelor's degree preferred.
• Minimum of 2 years of Audit or Quality Assurance experience.
• Minimum of 2 years of Insurance related experience (preferably TPA).
• Benefit Software and QA knowledge preferred.