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Corporate Functions & Operations WellCare - Quality & Audit Careers

Quality & Audit Specialist Job

Full Job Title: Quality and Audit Specialist

Job Number: 1802356

Location: Tampa, FL

Date Posted: 4-2-2018

Department: Pharmacy

Reports to: Manager Quality and Audit

Location: 4110 George Road, Tampa FL 33634

Performs quality audits at user level as well as on departmental processes to assess compliance with WellCare's contractual and regulatory requirements.

Essential Functions:

  • Conducts daily, weekly, monthly Quality audits at the user level as well as on department processes ensuring accuracy across multiple systems.
  • Prepares detailed audit samples and supporting documentation for external and internal audits.
  • Researches and documents audit findings, compiles feedback, responds to rebuttals and maintains data within various departmental tracking tools.
  • Tracks and maintains quality results for appropriate distribution.
  • Maintains a working knowledge of Medicare and Medicaid regulations and guidelines.
  • Maintains a full understanding of department processes in order to research and identify improvement opportunity options.
  • Assists with special projects and other duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A High School or GED
  • Preferred A Bachelor's Degree in a related field
  • Preferred or equivalent work experience
Candidate Experience:
  • Required 3 years of experience in Internal experience: a healthcare organization; preferably in Enrollment / Customer Service / CTM / Grievance processes.
  • Required 4 years of experience in External experience: a healthcare organization; preferably in Enrollment / Customer Service / CTM / Grievance processes.
Candidate Skills:
  • Intermediate Ability to multi-task
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Other Ability to remain calm under pressure
  • Intermediate Other Ability to perform detailed review, research, and analysis to ensure Operational accuracy across multitude of systems
  • Intermediate Other Uses tact and diplomacy when performing job duties
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft PowerPoint

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Last Updated On: 12/9/2015