Sr FEP Quality Assurance Auditor

The hiring range for this role is:  

92,086.00 - 129,145.00

The role plans and performs Government Agency mandated performance program audits, ensuring BCBSA and Plans resolve customer interactions accurately and timely. They validate reported performance results, analyze performance to enhance controls, and develop audit recommendations. The auditor drafts and issues audit reports, presents updates and recommendations during audits and at events like Townhall calls and conferences, and coordinates all quality assurance audit activities. They support BCBSA and Plans in resolving audit recommendations and ensure responses are accurate, timely, and address quality assurance audit recommendations.

• Responsible for auditing Plans performance results and lead cross-functional meetings with BCBSA and Plan stakeholders in order to facilitate the development and completion of action plans for each performance program under the BCBSA Program.
• Assist in the development and administration of various audit initiatives/programs that impact internal and external stakeholders, including: Claim Processing Accuracy, Claims Coding Accuracy, Recovery of Erroneous Payments, Coordination of Benefits, Claims Timeliness, Processing ID Cards, Member Inquiries, Written Inquiries Accuracy, Telephone Inquiry Accuracy, Internet Inquiries Accuracy, Telephone Access and Responsiveness to FEHB Member request for Reconsideration.
• Provide BCBSA and Plan training and support to properly execute operational and audit requirements for the Quality Assurance Review (QAR) and other audits assigned under the BCBSA Program in either formal or informal settings on a scheduled or ad-hoc basis. This includes providing face-to-face training, webinars, one-on-one meetings, and collaborating with other BCBSA teams.
• Prepare BCBSA or Plan information request, audit inquiries and audit resolution supporting documentation to ensure it is accurate and complete.

Education
Bachelor degree or equivalent work experience
Experience (Required)
Minimum of 5 years knowledge of health care claims processing

Experience (preferred)

Experience auditing BCBSA and Affiliated companies
Experience auditing government regulations

Skills
• Knowledge of Government Programs
• Knowledge of claims processing
• Strong research and analytical skills
• Strong communication skills both oral and written
• Presentation Skills
• Knowledge of Microsoft Office suite
• Audit Report writing

Preferred Certification::
Legal, Risk, Contracts & Governance\IIA - Certified Internal Auditor (CIA)
People Management
No

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