Quality Auditor - The Health Plan *Remote*

About Texas Children's Hospital

Summary:

We are searching for a Quality Auditor-- someone who works well in a fast-paced setting. In this position, you will be responsible for reviewing and evaluating the quality and effectiveness of the department policies and procedures, processes, and system updates such as member eligibility, provider setup, benefit/contract/edit configuration, and/or code/rate updates. This role will partner with the department managers on audit findings to ensure identified errors are promptly and appropriately corrected, as well as identified performance and/or training gaps are addressed. The Quality Audit also tracks and reports quality metrics for the department and serves as the department's point of contact for audit inquiries.

Think you’ve got what it takes?

 Job Duties & Responsibilities
•    Review and evaluate the quality, accuracy, and timeliness of system updates such as member eligibility, provider setup, benefit/contract/edit configuration, and/or code/rate updates
•    Create a tracking and reporting mechanism for audits to be able to share findings with the department managers and assist with identifying performance and training gaps
•    Develop and track quality metrics for the department that are reported to leadership on a routine basis and incorporated into the departmental dashboard
•    Identify and report process improvement opportunities for the department to increase efficiencies, performance, and quality
•    Assist with the production of various reports regarding the department’s quality and performance
•    Develop and maintain policies and procedures for the departmental audit program

Skills & Requirements
•    High school diploma or GED required
•    Bachelor’s degree in healthcare administration, business administration, computer science or related field preferred 
•    2 years Medicaid Managed Care experience required
•    4 years health plan operations experience required
•    4 years health plan payer systems/applications experience required
•    2 years auditing/quality/review/training experience preferred
•    Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption.

**Experience and/or knowledge of provider/ managed care contracting workflow processes highly preferred**

**Position is fully remote capable for both in and out of state applicants, some exclusions may apply**