QUALITY ASSURANCE SPECIALIST 8/20/2020
JOB DESCRIPTIONAPPLY About HealthSmart
HealthSmart is the premier provider of customizable and scalable health plan solutions for self-funded employers. We reduce costs and improve outcomes, all the while treating our health plan members with dignity and respect. But that's just the beginning of our story - We make differences in peoples' lives every single day!
We're a company of innovators.
We deliver health benefit plans and solutions to provide worry-free, self-funded plan administration, quality coverage, and innovative care.
We provide care management services that change lives and helps employers and members take control of healthcare costs.
HealthSmartRx Solutions delivers extremely attractive pharmacy benefits with an Rx discount program.
Our Network Solutions group offers national, comprehensive provider networks to provide member access to the right care.
HealthSmart Casualty Claims Solutions leverages technology, robust information and unmatched experience to deliver innovative casualty claims management solutions with outstanding results.
We offer business intelligence and web-based reporting. Plus, we offer a variety of health and wellness initiatives and even onsite employer clinics.
At HealthSmart, the Quality Assurance Specialist will provide support to the department responsible for maintenance of provider data collected to support various functions including claims processing and provider network and encounter reporting to regulatory agencies. Assists with performing quality reviews and ensuring control procedures are followed. Identifies, researches, resolves and reports all discrepancies related to claims processing and reimbursement, procedural issues and quality data transmissions. This position will also be responsible for the processing of incoming provider rosters.
* Must have Access knowledge
* SQL skills
* Experience in healthcare industry
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Generating notification and results of audits
* Creation and maintenance of reports
* Maintaining electronic and paper documentation
* Document findings
* Conducts Quality Assurance Audits as directed.
* While performing the duties of this job, the employee is frequently required to sit, talk, and hear.
* The employee is occasionally required to walk; use hands and fingers to feel, handle, or operate objects, tools, or controls; and reach with hands and arms.
* The employee must occasionally lift and/or move up to 30 pounds.
* Specific vision abilities required by this job include close vision and the ability to adjust focus.
* The work is performed primarily in an office setting.
* The noise level in the work environment is moderate
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.
HealthSmart provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training..