Operations Quality Auditor
AmeriHealth Mercy Family of Companies - Philadelphia, PA

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Job Title : Operations Quality Auditor

Job Summary:

Under the direct supervision of the Supervisor, Manager and/or Director of Operations Quality Auditing, responsible for the timely and accurate review of various tasks performed by Operations (including, but not limited to, claims processing, call handling and member/provider data maintenance).
  • Identifies system and/or operational issues hindering the attainment of quality performance standards as defined by AMFC policy and associated business rules. Provides issue identification, problem analysis and strategies for resolution and/or implementation to Management.
  • Accurately documents audit findings in the appropriate quality tool.

Job Related Experience and Skills
  • 3-5 years’ experience
  • Minimum 3 years’ claims experience in a Medicaid environment
  • Bachelor’s Degree
  • Other Skills:
    • Claims processing knowledge required, preferably with the Facets system
    • Working knowledge of Microsoft Office applications
    • Experience in call center ops and member/provider database maintenance preferred

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