Claims and Quality Mgmt System Auditor

Birdsong Hearing Benefits - Jacksonville, FL

Full-time - Mid Level

Jacksonville, FL

About the position

The Claims and Quality Management System Auditor plays a crucial role at Your Hearing Network (YHN), responsible for ensuring adherence to quality assurance principles, identifying training needs, and collaborating with internal teams to analyze system requirements and claims coding. This position involves auditing submitted claims and patient files, overseeing training delivery, and developing training materials to support annual quality training. The auditor will also maintain quality control processes and report findings to the executive team.

Responsibilities

• Plan, coordinate, develop and implement approved projects to enhance operational efficiency.
• Compile and report accuracy errors found during audits to various leadership levels.
• Provide project status updates to the leadership team and recommend policy decisions.
• Perform special audits of provider payments as requested by regulators and management.
• Represent the department on work groups and special assignments related to testing.
• Function as a subject matter expert in audit functions and claims processing.
• Identify documentation defects and present recommendations for improvement.
• Maintain standard operating procedures (SOPs) for auditing procedures and review regularly.
• Develop and implement quality control audit plans and testing parameters.
• Train employees on quality standards and procedures.
• Document defects and recommendations for improvement and prepare quality audit reports for senior management.
• Keep abreast of industry standards and regulations and utilize technical skills for electronic tools.
• Conduct thorough assessments and audits of processes to ensure compliance with quality standards and regulations.

Requirements

• Bachelor's degree in education, Instructional Design, Communications or related discipline preferred.
• Four years of experience in claims administration, quality assurance, and/or auditing functions.
• Proven experience in group presentations and leading special projects.
• Ability to design and produce training materials based on the Instructional Design Process.
• Demonstrated attention to detail in auditing practices and clear communication skills.
• Highly proficient in MS Office applications.
• Ability to work with complex and sensitive information while maintaining confidentiality.
• Excellent written and verbal communication skills.

Nice-to-haves

• Knowledge of quality assurance, quality systems, internal auditing, and quality improvement.
• Basic knowledge of data analysis, statistics, and data integrity.

Benefits

• On-the-job training
• Professional development opportunities