Job Abstract

The Customer Solution Center Enrollment Quality Control Auditor II is responsible for auditing process analysis and evaluation. This position will participate in implementing the process enhancements that will facilitate the optimal performance of the department processes and functions.  

Conduct research and comprehensive analyses to aide in departmental and organizational goals, initiatives, and decision making. Perform the validation of various standard and ad hoc reports, auditing of member eligibility, assignment, and demographic information, and/or audit materials related to mailing fulfillments. Collaborate closely with the Membership Information Supervisor, Senior Report Writers/Analysts, and various other internal and external stakeholders to implement new databases, queries, and reports (and update existing ones) to help facilitate the timely, accurate reflection of membership information for all lines of business in the systems, in accordance with regulatory and organizational guidelines. (35%)

Compile, prepare, and present various related reports, analyses, summaries, and correspondence to aid in management decision-making, implementation of systems and process enhancements, etc.
Collaborate cross-functionally with external stakeholders, consultants, and vendors as well as internal staff on the review/update of business and technical requirements documents, user acceptance testing; etc. (30%)

Recommend process solutions and enhancements to management. Facilitate in the  implementation of approved systems and process solutions/ enhancements. (25%)

Perform other duties as assigned. (10%)

Required:
At least 0-1 years of quality control auditor or auditing experience in a managed care or healthcare field setting.

Experience with and knowledge on Medi-Cal, Medicare, Market Place/Exchange, Commercial and Individual lines of business and other related government-funded/sponsored healthcare programs which include, but not limited to TRR, HCO or 834 electronic files.

Project management experience

Required:
Intermediate computer skills (including Microsoft Access, Excel, Word, and PowerPoint).

Excellent customer service and membership processing systems such as QNXT, MHC, or MHS.

Strong analytical and problem-solving skills.

Strong organizational skills.

Strong interpersonal, verbal, and written communication skills.

Strong leadership, team-building, customer service, and presentation skills.

Preferred:
Customer Service Training