The primary purpose of the Operations Quality Analyst is to provide high level technical expertise and analysis to the Community Health Choices Service Coordination department.
They will work closely with configuration, PDM and the Plans to identify root cause and drive to resolution.
Function as a key subject matter expert for all Community Health Choices Service Coordination activities.
Have experience in auditing and quality review specific to service coordination activities.
Maintain a current working knowledge of contractual guidelines, Plan policy and operational procedures to effectively provide subject matter expertise.
Support the Community Health Choices Service Coordination team in identifying issues for quick remediation.
Assist in analysis of target audits as required.
Ability to communicate and represent the Community Health Choices Service Coordination team to the Enterprise, the health plan and outside auditors.
Utilize various technology applications related to quality review data collection and analysis. (Excel/Access/Word).
Identify audit trends and provide recommendations.
Train any new QA staff.
Extensive claim experience.
Strong understanding of facets applications.
Critical thinking skills.
Proficient in MS Excel and Word.
Bachelor’s Degree or equivalent experience.
Education: Bachelors Degree