Performance Measurement Specialist I - External Auditing - Remote (Select States)

City/State

Norfolk, VA

Overview

Work Shift

First (Days) (United States of America)

Sentara Health is currently seeking a full-time remote Performance Measurement Specialist I.

Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming

For those located in Washington State, the following salary range applies: $43,888.00 - 62,768.16

Job Description Summary

Responsible for the development and the oversight of the Quality Program Customer Operations Department specific to all areas of enrollment and group information related to member, employer, and eligibility. Provides quality service and customer satisfaction through accurate auditing insurance application data including demographics, auditing of insurance group data including benefits, rates, fees, and demographic data and auditing of appeals cases for the Federal Facilitated Marketplace. Additional responsibilities include but not limited to project management for internal and external audits, identifying and implementing process improvements to support the business needs. Prepare and track an audit work plan and customize audit solutions for internal and external audits. The Performance Measurement Specialist serves as a resource for Customer Operations/external departments.

The external auditing team is responsible for independently reviewing and assessing SHP processes, financial accuracy, and compliance with regulations to ensure accuracy, integrity, and adherence to standards, policies and procedures.

Required Education:

High grad or equivalent

Job Requirements:

3 years experience in Auditing Required

QNXT & Excel experience Preferred

Sentara Benefits:

Sentara employees strive to make our communities healthier places to live. We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, https://www.sentaracareers.com/explore-sentara/benefits/

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

Job Summary

The position is responsible for the execution of operations random and focus audits. Assess company operations, process, compliance and other associated risks. Prepare and present quality reports of audit findings and recommendations to Manager and customers. Develop strategic initiatives to maintain and improve the audit function. Evaluate and revise internal controls and operational and management policies/procedures. Support External Audits for CMS, DMAS, and Groups .

3 years experience in Claims Processing, Customer Service, Enrollment or System Administration required. (Not required for Sales Positions)

Sales experience preferred, not required.

Qualifications:

HS …