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Full-Time

Quality Audit Specialist

Confirmed live in the last 24 hours

HCSC

HCSC

Healthcare

Compensation Overview

$17.5 - $36.76Hourly

Entry, Junior

Chicago, IL, USA

Hybrid schedule requires 3 days in office at 300 E. Randolph, 8am - 4:30pm.

Category
Auditing
Accounting
Requirements
  • High school diploma or GED.
  • 2 years in a health care production or health care provider services production environment.
  • 2 years’ experience where quality audits are performed.
  • Clear and concise interpersonal, verbal and written communication skills.
  • Knowledge of Managed Care products, programs, and services.
  • Knowledge of managed care providers and provider databases.
  • Analytical skills; organizational skills; and timely assignment completion of daily work and/ or assigned projects.
  • PC experience and skills to include Word, Excel, Access, Dashboard, Blue Star, Vistar or similar word processing spreadsheets (Windows environment) software.
Responsibilities
  • Ensuring the accuracy of auditing IE, Hedis, NCQA data.
  • Documenting quality performance audits.
  • Maintaining quality assurance statistics.
  • Custodian for the department record retention processes.
  • Participates in Hedis administrative (clerks) interviews.
  • Develops a training manual.
  • Provides training and coordinates daily tasks of the Hedis clerks.
  • As a Qi team member, provide support of disease management and clinical intervention activities as directed.
  • Conducts auditing of quality of service complaints, which include: reviewing service complaints; developing tracking system for complaints; generating form letters; identifying provider/clinics; assessing, and researching the complaint; analyzing, resolving and communicating resolution of the quality of service complaint to members; notifying providers and network services of the complaint and its resolution.

Company Stage

N/A

Total Funding

$472.7M

Headquarters

Chicago, Illinois

Founded

N/A

Simplify Jobs

Simplify's Take

What believers are saying

  • The new Houston office will create numerous job opportunities, fostering local economic growth and community development.
  • The acquisition of Cigna's Medicare businesses will expand HCSC's product offerings and geographic reach, benefiting current and future members.
  • Recognition as one of the 'Best Places to Work in IT' and having a CEO listed among the 'Most Influential People in Healthcare' highlight HCSC's strong leadership and positive work environment.

What critics are saying

  • The $231,900 fine from the Illinois Department of Insurance for an inaccurate provider directory could damage HCSC's reputation and trust with members.
  • The integration of Cigna's Medicare businesses may pose operational challenges and potential disruptions.

What makes HCSC unique

  • HCSC's strategic expansion into local communities, such as the new Houston office, emphasizes its commitment to economic growth and local workforce development, setting it apart from competitors.
  • The acquisition of Cigna's Medicare businesses significantly enhances HCSC's capabilities and reach in the growing Medicare market, providing a competitive edge.
  • HCSC's collaboration with Feeding America to address root causes of hunger showcases its holistic approach to community health, beyond traditional healthcare services.