Audit Support Specialist - Remote
Clarks Summit, PA Clarks Summit, PA $50,000 - $60,000 a year $50,000 - $60,000 a year Audit Support Specialist JOB SUMMARY This position is responsible for auditing care records, inclusive of client and caregiver files, in a timely and efficient manner.
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES Develops and implement audit strategies and plans to assess the quality of care and compliance with regulations.
Responds to requests from external auditors (e.
g.
, payors or regulators) timely, including quality of care concerns, payor record requests, and re-credentialing audits.
Reviews documentation provided to external audit request and collaborates with internal stakeholders to achieve best possible outcomes on external audits.
Conducts audits of processes, procedures, and systems to ensure compliance with quality standards and regulations.
Identifies and communicate audit findings and recommendations to senior management and other stakeholders.
Works with teams to develop action plans to address audit findings and ensure corrective actions are implemented.
Stays up to date with changes in quality standards and regulations to ensure audit processes are current and effective.
Ensures compliance with relevant regulations, laws, and industry standards, as well as organizational policies and procedures.
Builds and maintains relationships with internal and external stakeholders, including healthcare providers, regulatory agencies, and patients or clients.
Collaborates with other departments (Operations, HR, Program Enrollment, IT, etc.
) to conduct audits.
May lead projects and perform other duties as assigned.
Occasional business travel throughout Pennsylvania is expected.
SUPERVISORY RESPONSIBILITIES N/A KNOWLEDGE, SKILLS AND ABILITIES Understanding of healthcare regulations, laws, and standards, as well as industry best practices and emerging trends.
Strong analytical skills and the ability to analyze data sets and identify opportunities for improvement.
Process improvement skills and experience.
Highly detail oriented and organized.
Proficient in Microsoft office packages (Word, Excel, and Outlook).
Excellent interpersonal and communication skills, including the ability to build and maintain effective relationships with diverse stakeholders.
Demonstrate ability to work collaboratively across departments and functions.
A commitment to quality, safety, and patient-centered care.
Must be results oriented, customer focused, and exhibit good interpersonal skills.
Must be able to travel to any of our offices throughout Pennsylvania, as well as CT, MA, NY, CT, FL, NJ, WV if needed.
EDUCATION AND TRAINING Bachelor's Degree; preferably in business, legal, healthcare, or related field.
Two (2) plus years of experience.
Or equivalent combination of education and/or experience.
Other Competencies Drive for Results - Establishes aggressive goals and takes appropriate, calculated risks to achieve results.
Acts with a sense of urgency regarding personal and organizational goals and priorities.
Demonstrates discipline and does the right thing, even when it is difficult.
Shows determination and persistence in the face of challenges.
Customer-Focus - Listens to understand the customer's perspective and is patient with their frustrations and struggles.
Anticipates customer needs and demonstrates commitment to exceeding their expectations.
Shares ideas on how to enhance the customer experience.
Builds rapport with customers through being empathetic and demonstrating reliability.
Self-Awareness - Thinks through possible outcomes and impact on others before taking action.
Recognizes strong emotional reactions and directs the energy into productive behavior and communication.
Can articulate personal values and aspirations.
Leverages personal strengths while working on managing weaknesses.
Valuing Others - Values and embraces the individuality of others by treating everyone with dignity, respect, and compassion.
Appreciates other cultures and perspectives and seeks common ground through listening and demonstrating empathy.
Credits others for their contributions and accomplishments.
Builds relationships across the organization through transparency and extending trust to others.
Learning Agility and Development - Seeks after and takes on challenging assignments to broaden skills and perspective.
Proactively seeks out resources to support personal development (books, articles, online resources, company resources, subject matter experts, etc.
) Reflects on and discusses successes and failures to learn and strive for continuous improvement.
Continuously seeks feedback from peers and leaders on growth opportunities.
Innovation - Seeks and shares ideas to improve work processes, from small tweaks to large changes.
Applies the creative ideas from others and embraces opportunities to pilot and experiment.
Reflects on and discusses how new ideas and processes impact other teams and the customer.
Adjusts to changing conditions and finds ways to get the work done Core Values We treat everyone with dignity and RESPECT We earn the TRUST of our members, and each other We provide RELIABLE services that open doors We serve with courtesy and COMPASSION We prioritize SAFETY We communicate with purpose and TRANSPARENCY COMMENTS:
The above statements are intended to describe the general nature and level of work being performed by individuals in this position.
Other functions may be assigned, and management retains the right to add or change the duties at any time.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES Develops and implement audit strategies and plans to assess the quality of care and compliance with regulations.
Responds to requests from external auditors (e.
g.
, payors or regulators) timely, including quality of care concerns, payor record requests, and re-credentialing audits.
Reviews documentation provided to external audit request and collaborates with internal stakeholders to achieve best possible outcomes on external audits.
Conducts audits of processes, procedures, and systems to ensure compliance with quality standards and regulations.
Identifies and communicate audit findings and recommendations to senior management and other stakeholders.
Works with teams to develop action plans to address audit findings and ensure corrective actions are implemented.
Stays up to date with changes in quality standards and regulations to ensure audit processes are current and effective.
Ensures compliance with relevant regulations, laws, and industry standards, as well as organizational policies and procedures.
Builds and maintains relationships with internal and external stakeholders, including healthcare providers, regulatory agencies, and patients or clients.
Collaborates with other departments (Operations, HR, Program Enrollment, IT, etc.
) to conduct audits.
May lead projects and perform other duties as assigned.
Occasional business travel throughout Pennsylvania is expected.
SUPERVISORY RESPONSIBILITIES N/A KNOWLEDGE, SKILLS AND ABILITIES Understanding of healthcare regulations, laws, and standards, as well as industry best practices and emerging trends.
Strong analytical skills and the ability to analyze data sets and identify opportunities for improvement.
Process improvement skills and experience.
Highly detail oriented and organized.
Proficient in Microsoft office packages (Word, Excel, and Outlook).
Excellent interpersonal and communication skills, including the ability to build and maintain effective relationships with diverse stakeholders.
Demonstrate ability to work collaboratively across departments and functions.
A commitment to quality, safety, and patient-centered care.
Must be results oriented, customer focused, and exhibit good interpersonal skills.
Must be able to travel to any of our offices throughout Pennsylvania, as well as CT, MA, NY, CT, FL, NJ, WV if needed.
EDUCATION AND TRAINING Bachelor's Degree; preferably in business, legal, healthcare, or related field.
Two (2) plus years of experience.
Or equivalent combination of education and/or experience.
Other Competencies Drive for Results - Establishes aggressive goals and takes appropriate, calculated risks to achieve results.
Acts with a sense of urgency regarding personal and organizational goals and priorities.
Demonstrates discipline and does the right thing, even when it is difficult.
Shows determination and persistence in the face of challenges.
Customer-Focus - Listens to understand the customer's perspective and is patient with their frustrations and struggles.
Anticipates customer needs and demonstrates commitment to exceeding their expectations.
Shares ideas on how to enhance the customer experience.
Builds rapport with customers through being empathetic and demonstrating reliability.
Self-Awareness - Thinks through possible outcomes and impact on others before taking action.
Recognizes strong emotional reactions and directs the energy into productive behavior and communication.
Can articulate personal values and aspirations.
Leverages personal strengths while working on managing weaknesses.
Valuing Others - Values and embraces the individuality of others by treating everyone with dignity, respect, and compassion.
Appreciates other cultures and perspectives and seeks common ground through listening and demonstrating empathy.
Credits others for their contributions and accomplishments.
Builds relationships across the organization through transparency and extending trust to others.
Learning Agility and Development - Seeks after and takes on challenging assignments to broaden skills and perspective.
Proactively seeks out resources to support personal development (books, articles, online resources, company resources, subject matter experts, etc.
) Reflects on and discusses successes and failures to learn and strive for continuous improvement.
Continuously seeks feedback from peers and leaders on growth opportunities.
Innovation - Seeks and shares ideas to improve work processes, from small tweaks to large changes.
Applies the creative ideas from others and embraces opportunities to pilot and experiment.
Reflects on and discusses how new ideas and processes impact other teams and the customer.
Adjusts to changing conditions and finds ways to get the work done Core Values We treat everyone with dignity and RESPECT We earn the TRUST of our members, and each other We provide RELIABLE services that open doors We serve with courtesy and COMPASSION We prioritize SAFETY We communicate with purpose and TRANSPARENCY COMMENTS:
The above statements are intended to describe the general nature and level of work being performed by individuals in this position.
Other functions may be assigned, and management retains the right to add or change the duties at any time.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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