Quality Audit Associate (Not IT)

Quality Assurance Audit Associate *Not an IT position*

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

JOB SUMMARY

This position conducts daily, and weekly review and audits of work performed in various operational areas to ensure continual adherence to defined business processes and procedures. Audit review requires incumbent to regularly interpret and fairly apply processing guidelines to live work. Education, resources, goals, and priorities will be provided; however, strong decision-making and critical thinking skills are paramount. Many audit scenarios are not clearly defined by processing rules and still must be comprehensively evaluated. The driven, results-oriented incumbent will work to identify defects, issues and/or trends present in new and existing processes while working to identify "root cause" of all defects incurred. Defects include, but are not limited to, those occurring at the employee level (caused by improper execution and/or lack of education or comprehension) as well as those occurring at the process level (caused by outdated or incorrect processing rules, outdated, incorrect or inconsistent process documentation and/or system defects).

DUTIES

1. Conduct and manage weekly assignments, including section of work for audit, in a consistent and timely manner while ensuring continual compliance with department policies. These assignments will be varied in complexity and volume based off department and business partner needs.
   2. Ensure consistent identification of new and known defects within each process subject to audit. Not all defects and scenarios will have clear definition in processing instructions therefore it is necessary to use critical thinking to evaluate intent and decision-making skills to draw an equitable conclusion.
   3. Confirm the validity of identified issues using process documentation and acquired knowledge and determine their downstream impact to evaluate criticality of defects. Escalating critical issues to senior management as needed.
   4. Ensure audit documentation describes and substantiates audit findings and also addresses expected course of action to assure efficient resolution of defects.
   5. Develop and maintain domain expertise of business rules specific to the assigned area of audit. Collaborate with management, peers and/or business process owners to maintain a complete understanding of business area process goals and intent, staying current with regular changes to rules, wiki and/or process documentation, business expectations, and best practices within each process audited, as well as the other business processes impacted by or related to each process. Attain a general understanding of all company processes and the impact any specific process has on the whole.
   6. Utilize acquired process specific and broad company knowledge to facilitate efficient training and coverage of cross-department projects as needed by business areas. Remaining flexible and ready to apply QA mentality to any ad hoc work to ensure quality results.
   7. Proactively and continually seek opportunities to increase knowledge and understanding. Learn from experience, others, mistakes and challenges. Ask questions to ensure conceptual understanding of processes and priorities. Contributing experiences and acquired knowledge to internal processing resources.
   8. Develop and maintain expertise within all department utilized applications and systems.
   9. Meet all applicable audit deadlines and ensure audits are completed within expected turn-around time (TAT's). Managing workload according to stated and shifting priorities.
   10. Ensure department performance and production standards are maintained through consistent achievement of departmental goals.
   11. Ensure systematic data-oriented efforts to improve consumer and/or client services are continually maintained. 95% of this job is related to QM activities
   12. Collaborate, coordinate, and communicate across disciplines and departments
   13. Attend team meetings and openly participate in discussions regarding operational procedures and quality updates.
   14. Ensure compliance with HIPAA regulations and requirements.
   15. Demonstrate commitment to the Company's core values.
   16. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High-Risk Role.
   17. Responsible for internal monitoring and auditing of compliance risks, prompt response to compliance issues as they are raised, investigation of potential compliance problems as identified in the course of self-evaluation and audits, correction of such problems promptly and thoroughly to reduce the potential for recurrence as required by applicable state and federal laws, regulations and MPI's Compliance Programs
   18. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE: This role works under general supervision in a self-direct results-oriented manner. The incumbent will rely and draw upon an expert understanding of position roles and responsibilities to independently complete tasks while remaining within established standards and procedures. Work performed will be varied and complex in nature. Use of decision-making skills and application of acquired knowledge are essential for quality performance.

COMPENSATION

The salary range for this position is $22 to $24 per hour.  Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity.  This position is also eligible for health insurance, 401k and bonus opportunity.