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MTM Performance Auditor job in Washington at CareFirst

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MTM Performance Auditor at CareFirst

MTM Performance Auditor

CareFirst Washington, DC Full-Time
**Resp & Qualifications**

**Purpose** **:**

Responsible for systematic investigations of a specific area of operations (i.e., claims, customer service, enrollment) within the organization. Incumbent conducts a variety of audit activities which may include, but not be limited to, process audits where there is a technology component, operational audits involving internal and/or external process and procedures, and audits of vendors/partner contracted services. In addition, the incumbent is responsible for ensuring QA testing is thorough and accurate in ensuring the audits under review adhere to company policies and procedures, audit methodologies, BCBSA guidelines and all applicable regulations. Serves as subject matter expert and resource to junior staff.

**Essential Function** :

Serves as the subject matter expert for Quality Assurance area. Perform quality assurance audits to investigate all aspects of the systems and/or procedures in place to ensure consistent and reliable product quality. Review the official lines of authority put in place to drive Q/A initiatives, the systems put in place to continually drive product quality higher and the monitoring of systems and/or procedures used to review the effectiveness of Q/A efforts. Lead and participate in the completion of validating the accuracy of audits accordance with established guidelines. This position will also lead efforts related to other internal/external audits and quality assurance programs in support of corporate programs. Lead activities to document and convey operational requirements to proactively enhance outcomes.

Perform follow-up activities related to audits/reviews and special projects thus ensuring that corrective action have been appropriately taken. Provides coaching/mentoring to more junior auditors members and provide guidance on complex work efforts. Assist with special projects and/or departmental initiatives that require subject matter expertise in a consultative manner. Monitor operations and test outputs to ensure consistent quality by identifying errors and opportunities to improve. Review audit findings with both the assigned client group and leadership to ensure audit findings are accurate, fair and agreement has been achieved. Perform subsequent follow up on all audit findings with the assigned client group for manual or system corrections/adjustments as required. Advise leadership of any disagreements or noncompliance to these requirements.

Submit audit findings to assigned client areas and leadership that outline the root cause of identified issues as well as provide recommendations for corrective action, system and procedural modification and enhancements to improve service and quality. Issues may include, but are not limited to: weaknesses, inconsistencies and inaccuracies in procedures, controls and system integrity. Compile, analyze and report any fraudulent activity or information to the appropriate departments. This information or activity may represent a potential risk to the organization, its subscribers, accounts and providers.

**Qualifications** **:**

Education Level: Bachelor's Degree. In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 5 years Auditing experience


Recommended Skills

  • Auditing
  • Claim Processing
  • Coaching And Mentoring
  • Corrective And Preventive Action (Capa)
  • Customer Service
  • External Audits
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Job ID: 2325104949

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