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*Claims Audit Specialist - Tampa

Company: Wellcare Health Plans
Location: Tampa
Posted on: September 15, 2019

Job Description:

Independently performs end to end audits of Operational area to ensure accuracy of departmental processes as they trace back to source and identify (if necessary) process improvement opportunities.Department: OperationsReports To: Manager, Claims AuditLocation: Tampa, FL 33634Essential Functions:Conducts daily quality reviews of operations department processes (i.e. eligibility, enrollment, claims processing and pricing, configuration contract loads, etc).Responds to first and second level rebuttals in a timely manner.Tracks and maintains quality results for appropriate distribution.Communicates audit results in a structured report format.Identifies and quantifies issues and recommend audit criteria to validate financial impact.Navigates audit tools and prepares ad hoc reports using Microsoft Excel or Access to summarize audit findings.Assists with identification and communication of process improvement opportunities across operation area's based on quality audit reviews.Assists with special projects and other duties as assigned. Additional Responsibilities:Candidate Education:Required A High School or GEDPreferred An Associate's Degree in a related field Candidate Experience:Required 2 years of experience in direct claims processing or provider configuration Candidate Skills:Advanced Knowledge of healthcare delivery Strrong functional knowledge of healthcare deliveryIntermediate Demonstrated interpersonal/verbal communication skillsIntermediate Ability to work independentlyIntermediate Ability to work as part of a teamIntermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 codingIntermediate Ability to work in a fast paced environment with changing prioritiesIntermediate Demonstrated time management and priority setting skillsIntermediate Demonstrated organizational skillsIntermediate Ability to multi-taskIntermediate Other Understanding of managed care and the health care industry in generalIntermediate Other Ability to understand and interpret contracts as related to claims processing or configurationIntermediate Other Decision making ability that requires the use of considerable judgment in the analysis of processes and problems/errors resulting from those processesIntermediate Other Knowledge of HCPCS CodingIntermediate Other Ability to remain calm under pressureIntermediate Other Ability to concentrate for extended periods on specific tasks Licenses and Certifications:A license in one of the following is required:Technical Skills:Required Intermediate Microsoft Excel Demonstrated technical expertise in performing quality reviews along with analysis of resultsRequired Intermediate Microsoft Outlook Knowledge of CPT/HCPCS CodingRequired Intermediate Microsoft Word Intermediate to Advanced knowledge of Microsoft officeRequired Intermediate Microsoft PowerPointRequired Intermediate Other Demonstrated technical expertise in performing quality reviews along with analysis of results Languages:About usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare Health Plans, Tampa , *Claims Audit Specialist - Tampa, Accounting, Auditing , Tampa, Florida

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