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.
Additional Responsibilities:Candidate Education:
- 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.
- Required A High School or GED
- Preferred A Bachelor's Degree in a related field
- Preferred or equivalent work 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.
Licenses and Certifications:
- 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
A license in one of the following is required:
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft PowerPoint