SCA Quality Auditor I or II
Posted on: 23 Jan 2021
Denison, TX
Job Description
Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At National Government Services (NGS), an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, its a powerful combination. Its the foundation upon which were creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
SCA Quality Auditor I or II
The SCA Quality Auditor is responsible for examining and evaluating the accuracy of transactions in accordance with regulations and company guidelines.
Primary duties may include, but are not limited to:
* Identifies documents and reports any transaction errors in a timely manner to ensure prompt resolution.
* Applies expert knowledge in most areas.
* Able to perform simple functions; works under general direction.
* Examines and evaluates on a prepayment basis the accuracy of transactions processed by reviewing policy, procedure and manual input in accordance with guidelines.
* Tracks and trends audit results, providing feedback to management.
* Generates monthly reports of audit findings, supports clients with issued identified, develops reports to assist management with information requested.
* Produces other ad hoc reports as requested by internal and external clients.
Qualifications
Qualifications:
* Requires H.S. diploma or equivalent;
* Level I: 9 months to 1 year related experience;
* Level II: 2 to 3 years related experience; A.S. degree preferred. SME in at least one operational area.
* Or, any combination of education and experience, which would provide an equivalent background.
Preferred skills
* A working knowledge of the Medicare program is required
* Experience processing Provider enrollment applications is preferred
* Medicare and Medicaid processing experience; claims, appeals, etc.
* PECOS, FISS, and/or MCS platform experience/ working knowledge
* Auditing of operational transactions experience
* Intermediate to advanced MS Office experience
* Navigating through SharePoint experience
* Strong verbal and written communication skills is required
* Must be able to work in a fast paced/ high volume environment
Non-negotiable hourly rate for this position by location.
Atlanta, GA
16.00
Baltimore, MD
16.00
Birmingham, AL
16.00
Cincinnati, OH
16.00
Denison, TX
16.00
Harrisburg, PA
16.11
Hingham, MA
17.68
Indianapolis, IN
16.12
Louisville, KY
16.00
Manchester, NH
16.00
Milwaukee, WI
16.66
South Portland, ME
16.00
Syracuse, NY
16.00
Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
Anthem, Inc.
Indianapolis, IN
Anthem, Inc., through its subsidiaries, operates as a health benefits company in the United States. It operates through three segments: Commercial & Specialty Business, Government Business, and Other. The company offers a spectrum of network-based managed care health benefit plans to large and small group, individual, Medicaid, and Medicare markets. Its managed care plans include preferred provider organizations; health maintenance organizations; point-of-service plans; traditional indemnity plans and other hybrid plans, such as consumer-driven health plans; and hospital only and limited benefit products.
The company also provides a range of managed care services to self-funded customers, including claims processing, underwriting, stop loss insurance, actuarial services, provider network access, medical cost management, disease management, wellness programs, and other administrative services. In addition, it offers an array of specialty and other insurance products and services, such as dental, vision, life and disability insurance benefits, radiology benefit management, and analytics-driven personal health care guidance; and Medicare administrative services.
Further, the company provides services to the federal government in connection with the Federal Employee Program; and operates as a licensee of the Blue Cross and Blue Shield Association. As of December 31, 2018, it served 40 million medical members through its affiliated health plans. The company was formerly known as WellPoint, Inc. and changed its name to Anthem, Inc. in December 2014. Anthem, Inc. was founded in 1944 and is headquartered in Indianapolis, Indiana.
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IndustryHealthcare
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No. of Employees63,900
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Website
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Jobs Posted1634
