Job Summary
The position performs regular audits designed to validate accuracy of information that is maintained by the department. The audits performed also validates those processes are performing in accordance with corporate and departmental policy and procedure. The associate level will have an aptitude to learn technology platforms such as Facets and OnBase. Responsible of routine inspection of at least two audit types (ie. Enrollment & Claims OR Claims and Product). This position ensures that all quality check procedures in the official quality program are followed during the inspection process. The associate level can demonstrate proficiency in performing the function as to what they audit such as Enrollments, Claims, Coding, Product, Coding or Processing across all funding and lines of business (Fully-funded, ASO, Medicaid, Medicare, Individual plans)
Essential Functions
- Performs audits according to department policies and procedures. Maintains and utilizes tools needed to track, trend and report audit results per department policy and procedure.
- Record results in an accurate and organized manner for the purpose of reporting individual and departmental results.
- Able to collaborate and explain/demonstrate the findings through the audit
- Looks for opportunities to learn from more experienced Business Systems Analysts.
- Confers with Quality staff and trainers to gain knowledge of work situations requiring training for employees to better understand changes in policies, procedures as well as changes in the Certificate of Coverage and Schedule of Benefits for various plans. May initiate procedure changes.
- Works under close supervision within established policies, practices and guidelines.
- Actively seeks to keep informed and updated on all software systems.
Qualifications
- Required Associate's Degree /Technical school or equivalent
- Preferred Bachelor's Degree or equivalent
- 2 years of relevant experience Managed care experience. Preferred
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Physical Demands
- Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs
- Waist to Waist > 5 lbs: Seldom up to 10 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 5 lbs
- Bilateral Carry > 5 lbs: Seldom up to 10 lbs
- Unilateral Carry > 5 lbs: Seldom up to 5 lbs
- Pushing Force > 5 lbs: Seldom up to 20 lbs
- Pulling Force > 5 lbs: Seldom up to 15 lbs
- Sitting: Frequently
- Standing: Occasionally
- Walking: Occasionally
- Forward Bend - Standing: Seldom
- Forward Bend - Sitting: Seldom
- Trunk Rotation - Standing: Seldom
- Trunk Rotation - Sitting: Seldom
- Squat: Seldom
- Supine Lying: Seldom
- Stair Climbing: Seldom
- Crawling / Kneeling: Seldom
- Driving: Seldom
- Reach - Above Shoulder: Seldom
- Reach - at Shoulder or Below: Seldom
- Handling: Occasionally
- Forceful Grip > 5 lbs: Seldom
- Forceful Pinch > 2 lbs: Seldom
- Finger/Hand Dexterity: Frequently
- Visual Acuity ¹
[None = No; Seldom = Yes]: Seldom
Primary Location
SITE - Priority Health - 1239 E Beltline - Grand Rapids
Department Name
PH - Operations Development and Quality
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
Variable
Days Worked
Monday to Friday
Weekend Frequency
N/A
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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.