The Quality Audit Coordinator 2 analyzes and investigates quality issues. The Quality Audit Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
Responsibilities
Humana is seeking a Quality Audit Coordinator to utilize strong administrative and interpersonal skills to collect routine data or information, medical records, conduct analyses, and communicate your findings verbally and in writing.
The Quality Audit Coordinator collects and reviews records, summarizes issues, works with Medical director as needed, and implements corrective actions as needed. Coordinates Peer review committees. Audits quality cases for compliance. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion. In this role you will:
Manages/monitors QMS for potential Provider Quality Issues (PQI) cases for division at least three times daily, assigns cases timely to appropriate Clinical Advisor
Verifies correct provider address and dates of service prior to sending request for medical records via MRM
Requests medical records as instructed by Clinical Advisor
Follows up with providers to ensure timely receipt of medical records in order to meet compliance goal
Documents all follow-up in QMS
Runs QMS reports
Processes medical record request invoices
Required Qualifications
Proficiency in all Microsoft Office applications, including Word, Excel and Outlook
Excellent communication skills, both verbal and written
Working knowledge of computers, or a demonstrated technical aptitude and an ability to quickly learn new systems
Preferred Qualifications
HS diploma
Associate's or Bachelor's Degree in Business, Finance or a related field
Experience in an Administrative or Customer Service role
Familiarity with medical terminology and/or ICD-10 codes
Knowledge of the healthcare insurance and/or Medicare industry
Additional Information
At Humana, we know your well-being is important to you, and it's important to us too. That's why we're committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.
Interview Format
As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.
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