To perform activities related to auditing, tracking, and documenting provider data for the Partnership HealthPlan of California (PHC) network. Assist Lead Auditor with training PR staff. Respond to provider inquiries.
Assist Lead Auditor with key auditing functions for the PR Department to ensure accuracy levels are maintained, including but not limited to:
SECONDARY DUTIES AND RESPONSIBILITIES
Education and Experience
High school diploma or equivalent; Associate’s Degree or certification in Healthcare processes a plus. Minimum five (5) years healthcare experience preferably in a managed care environment; or equivalent to combination of education and experience. Project coordination experience required.
Special Skills, Licenses and Certifications
Working knowledge of MS Windows related applications and experience with database applications, typing, and 10-key use. Knowledge of managed care concepts, policies, and procedures. Ability to understand, interpret, and prepare documentation related to regulatory requirements. Medical terminology required. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.
Performance Based Competencies
Excellent oral and written communication skills. Excellent organizational skills with ability to prioritize assignments, maintain accurate records, and meet deadlines. Ability to use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.
Work Environment And Physical Demands
Ability to use a computer keyboard and a 10-key calculator. More than 70% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying sizes, weighing up to 30 pounds.
All HealthPlan employees are expected to:
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.