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Health Plan Auditor I

2 months ago

Atlanta, United States Health Services Advisory Group Full time

The Auditor is a contributor to the Audits department's work that spans the broad spectrum of healthcare performance measurement projects at HSAG. Driven by intellectual curiosity and a passion for healthcare quality, this position performs-under supervision-healthcare auditing, data validation, and performance measurement projects through various stages including implementation, day-to-day operations, audit support, evaluation, and reporting. Activities include developing work plans and timelines; overseeing project tasks; guiding coordination staff in oversight and maintenance of project files; leading client teleconferences and meetings; performing online research on healthcare topics; leading primary source verification; validating performance results and outcomes; and providing regular progress reports to Data Science & Advanced Analytics management staff.

Details regarding potential project assignments will be discussed with potential candidates during the interview process.



Essential Competencies, Duties and Responsibilities

  • Serve as a contributing member of HSAG's Audits department within DSAA.
  • Act in a liaison capacity between appropriate management personnel and staff, transmitting decisions and information to organizational units as appropriate, as well as outside agencies and organizations, under supervision.
  • Lead project management tasks, including communication (written, phone, fax), under supervision.
  • Communicate with project partners, consultants, subcontractors, and other entities on audit and performance measure validation-related projects, under supervision.
  • Maintain, tag, and sort documents for assigned projects on appropriate SharePoint team sites and HSAG's corporate and federal networks following HSAG prescribed governance rules.
  • Prepare project deliverables and lead documentation and submission of deliverable using the appropriate mechanism (i.e., electronic, hard copy, direct data entry etc.), under supervision.
  • Develop and adhere to project time and task schedules, identify opportunities to improve the project process, and develop quality improvement activities accordingly.
  • Meet agreed-upon deadlines in a timely fashion and accurately prepare and type deliverables, reports, various project documents, letters, and other material from copy, rough draft, or other prescribed instructions.
  • Support development of written and data-oriented reports in Microsoft Word and Excel, under supervision.
  • Conduct research via the Internet including literature searches of clinical topics as assigned.
  • Participate in pertinent healthcare educational and training presentations as required.
  • Conduct Internal Quality Control (IQC) monitoring regarding efficiency/effectiveness of activities conducted. Present issues and recommended solutions and take corrective actions as indicated.
  • Serve as a reference to HSAG staff and clients on Healthcare Effectiveness Data and Information Set (HEDIS®)[1] measures and non-HEDIS performance measures as applicable.
  • Represent HSAG in a professional manner at all times.

[1] HEDIS Certified Measures® is a registered trademark of the National Committee for Quality Assurance (NCQA).



Education and/or Experience

  • Bachelor's degree in business, science, or healthcare-related field.
  • At least one year of work experience in healthcare is required; two years of work experience in healthcare is preferred.
  • At least one year of auditing experience is required.


Other Qualifications

  • Proficient English/communication skills (i.e., public speaking, spelling, composition, grammar, proofreading and editing).
  • Proficient interpersonal skills.
  • Experience in Microsoft Word, PowerPoint, and Outlook.
  • Experience in Microsoft Excel.
  • Experience in conducting research via the Internet.
  • Ability to handle several projects simultaneously and work with multiple teams.


Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.



Disclaimer

This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts or working conditions associated with the position. While this is intended to be an accurate reflection of the current position, management reserves the right to revise the position or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, work load, rush jobs requiring non-regular work hours, or technological developments).

HSAG is an EEO Employer of Veterans protected under Section 4212.

If you have special needs and require assistance completing our employment application process, please feel free to contact us.

EOE M/F/Vet/Disability