Quality Assurance Specialist
3.
6 Sherwood, AR Sherwood, AR Estimated:
$38.
1K - $48.
3K a year Estimated:
$38.
1K - $48.
3K a year 1 hour ago 1 hour ago 1 hour ago Quality Assurance Specialist At Delta Dental, we have a passion for making people smile.
And every day, our employees work to make that passion come to life.
We have been in existence since 1982 and have been voted Arkansas' Best Places to Work for eleven years in a row.
We are looking for a member of our team who is passionate about our mission to improve the oral health of Arkansans and ready to make a difference.
We have four core values that we stand by at Delta Dental of Arkansas:
Act with Integrity Respect People World-Class Service Focus on Community We believe in supporting our employees through a multitude of fantastic
Benefits:
Competitive pay with bonus opportunities Excellent insurance package including fully paid dental, short term disability, long term disability, and life insurance Education assistance 401(k) matching and profit-sharing plan Job
Summary:
Manages the daily relationship and interactions with external claims auditing partners, internal departments and the company.
Works closely with management for security and environment changes.
Primary Job
Responsibilities:
Assures the coordination of the selection of random audits for within a defined audit sample size and criteria across all departments.
Management will be notified when any inconsistencies are found.
Assures all processes and procedures are well documented and followed.
Individual accuracy ratings contribute to the department accuracy rating with a requirement of 99.
5%.
Conducts a monthly audit on the following areas; Benefit Coding Specialist, Claims, B&E, Electronic Eligibility and Employee Claims.
Conducts daily audits of Benefits Coding Specialists HIPAA related requests and ICS Claims.
Compiles monthly and year to date audit results by individual, manager, and department and reports to all management.
Various logs are used to track production totals etc.
Identifies and reports error trends.
Reviews employee securities in the claims system for violations of system access on a quarterly basis.
Collaborates frequently with internal staff and audit vendor partners to discuss error resolution.
Trains external auditors on company policies and procedures for claims processing, group billing and eligibility, new group set up, group changes/revisions and group renewals; reviews audits monthly bills to assure billing is correct in relation to the number of claims audited.
Maintains all security additions, updates and terminations for the production and test environments.
All users' activity is logged and kept for audit and verification.
Required to question any requests for security changes without proper management approval.
Any requests that could pose a potential breach of proper protocol should be questioned regardless of the requestor and reported immediately to Group Administration management for instructions of how to proceed before performing the initial request.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Minimum
Qualifications:
Will accept any suitable combination of education, training or experience.
Position requires a high school diploma or GED, 2 years insurance operations experience, intermediate experience working with spreadsheet software and basic experience working with 10-key and word processing.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
6 Sherwood, AR Sherwood, AR Estimated:
$38.
1K - $48.
3K a year Estimated:
$38.
1K - $48.
3K a year 1 hour ago 1 hour ago 1 hour ago Quality Assurance Specialist At Delta Dental, we have a passion for making people smile.
And every day, our employees work to make that passion come to life.
We have been in existence since 1982 and have been voted Arkansas' Best Places to Work for eleven years in a row.
We are looking for a member of our team who is passionate about our mission to improve the oral health of Arkansans and ready to make a difference.
We have four core values that we stand by at Delta Dental of Arkansas:
Act with Integrity Respect People World-Class Service Focus on Community We believe in supporting our employees through a multitude of fantastic
Benefits:
Competitive pay with bonus opportunities Excellent insurance package including fully paid dental, short term disability, long term disability, and life insurance Education assistance 401(k) matching and profit-sharing plan Job
Summary:
Manages the daily relationship and interactions with external claims auditing partners, internal departments and the company.
Works closely with management for security and environment changes.
Primary Job
Responsibilities:
Assures the coordination of the selection of random audits for within a defined audit sample size and criteria across all departments.
Management will be notified when any inconsistencies are found.
Assures all processes and procedures are well documented and followed.
Individual accuracy ratings contribute to the department accuracy rating with a requirement of 99.
5%.
Conducts a monthly audit on the following areas; Benefit Coding Specialist, Claims, B&E, Electronic Eligibility and Employee Claims.
Conducts daily audits of Benefits Coding Specialists HIPAA related requests and ICS Claims.
Compiles monthly and year to date audit results by individual, manager, and department and reports to all management.
Various logs are used to track production totals etc.
Identifies and reports error trends.
Reviews employee securities in the claims system for violations of system access on a quarterly basis.
Collaborates frequently with internal staff and audit vendor partners to discuss error resolution.
Trains external auditors on company policies and procedures for claims processing, group billing and eligibility, new group set up, group changes/revisions and group renewals; reviews audits monthly bills to assure billing is correct in relation to the number of claims audited.
Maintains all security additions, updates and terminations for the production and test environments.
All users' activity is logged and kept for audit and verification.
Required to question any requests for security changes without proper management approval.
Any requests that could pose a potential breach of proper protocol should be questioned regardless of the requestor and reported immediately to Group Administration management for instructions of how to proceed before performing the initial request.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Minimum
Qualifications:
Will accept any suitable combination of education, training or experience.
Position requires a high school diploma or GED, 2 years insurance operations experience, intermediate experience working with spreadsheet software and basic experience working with 10-key and word processing.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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