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Blue Cross and Blue Shield of Illinois, Montana, N Quality Audit Specialist in Helena, Montana



BASIC FUNCTION:Under supervision, this position is responsible for ensuring the accuracy of auditing i.e.,HEDIS, NCQA data; documenting quality performance audits, maintaining quality assurance statistics, and is the custodian for the department record retention processes; participates in HEDIS administrative (clerks) interviews, develops a training manual, provides training and coordinates daily tasks of the HEDIS clerks. As a QI team member provide support of disease management and clinical intervention activities as directed. Conducts auditing of Quality of Service Complaints, which include: reviewing service complaints; developing tracking system for complaints; generating form letters; identifying provider/clinics; assessing, and researching the complaint; analyzing, resolving and communicating resolution of the quality of service complaint to members; notifying providers and Network Services of the complaint and its resolutionJOB REQUIREMENTS:* High school diploma or GED.* 2 years in a health care production or health care provider services production environment.* 2 years experience where quality audits are performed.* Clear and concise interpersonal, verbal and written communication skills.* Knowledge of Managed Care products, programs, and services.* Knowledge of managed care providers and provider databases.* Analytical skills; organizational skills; and timely assignment completion of daily work and/ or assigned projects.* PC experience and skills to include Word, Excel, Access, Dashboard, Blue Star, Vistar or similar word processing spreadsheets (Windows environment) software.

PREFERRED JOB REQUIREMENTS:* Customer Service telephone experience highly desirable.* Knowledge of medical terminology or completion of medical terminology course.* Salary Expectation: $32,600 - Depending on experience.


Location: MT - Helena

Activation Date: Tuesday, February 23, 2021

Expiration Date: Wednesday, March 10, 2021

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