At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

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Job Summary

Under Supervision, This Position Is Responsible For Ensuring The Accuracy Of Auditing IE,Hedis, Ncqa Data. Documenting Quality Performance Audits, Maintaining Quality Assurance Statistics, And Is The 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.

Required Job Qualifications:

• 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.

Preferred Job Qualifications:

• Customer Service telephone experience highly desirable.
• Knowledge of medical terminology or completion of medical terminology course.
• Credentialing experience.
• Working knowledge and understanding of NCQA/MCO/CVO guidelines and standards.

*CA

#LI-Hybrid

Hybrid Schedule 3 days in office 300 E. Randolph- 8am -430p

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HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$17.50 - $36.76