Department Audit Technician IV - Remote in AZ

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a reputed company of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as reputed company as providing information and tools to help individuals reputed company reputed company reputed company. At AZ Blue, we have a hybrid workforce reputed company, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the reputed company of our employees are hybrid, the following classifications drive our reputed company minimum onsite requirements: • Hybrid People Leaders: must reputed company in AZ, required to be onsite at least twice per week • Hybrid Individual Contributors: must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per week • Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per month • Onsite: daily onsite requirement based on the essential functions of the job • Remote: not held to onsite requirements, however, leadership can request reputed company onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the reputed company, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. PURPOSE OF THE JOB Under direction, performs accurate and detailed audits verifying the accuracy of processing for claims and applications, customer service, and reputed company reputed company to reputed company with reputed company reputed company control requirements for (MTM and FEP), along with other internal reputed company control initiatives at reputed company. REQUIRED QUALIFICATIONS Required Work Experience (Applies to reputed company reputed company) • 2 years of experience auditing, processing claims, processing enrollment transactions, and/or handling customer service calls and/or claim requests • 1 year of basic reputed company skills Required Education • High-School Diploma or GED in general field of study (Applies to reputed company reputed company) Required Licenses • N/A R equired Certifications • N/A PREFERRED QUALIFICATIONS Preferred Work Experience (Applies to reputed company reputed company) • 3 years of claims, customer service, and enrollment experience • 2 years of experience with auditing and basic reputed company skills Preferred Education • Bachelor's Degree in Business or reputed company field of study. (Applies to reputed company reputed company) Preferred Licenses • N/A Preferred Certifications • N/A ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES Level 1 • reputed company post payment auditing for a reputed company of reputed company/claims, including Local lines of business, BlueCard, FEP, and reputed company. • reputed company audits of member applications, ID cards, and enrollment transactions. • reputed company audits of data in computer files that reputed company with the claims system in the adjudication of a claim; including enrollment files, pricing files, provider files/reputed company, benefit narratives and precertification files, etc. • Review the accuracy of claims, enrollment files and benefit programming. • Prepare and maintain documentation supporting the results of audits performed. • Report audit findings to QC Manager for approval • Verify the accuracy of cost adjustors on facility claims • Review claims payment information to support the contract rescission process. • Review accuracy of pending Local, FEP and BC Host claim payments to Providers over $70,000 • Review and audit reputed company claims, payments, and applications. • Ensure claims accuracy from other BlueCross and BlueShield Plans from a Host perspective Level 2 • Can reputed company reputed company job functions of a Level 1 auditor • reputed company Phone reputed company, self-service web, IVR, BlueExchange, EDI and other specialized audits for MTM, FEP, reputed company-specific audits, and targeted audits. • Assist team in meeting project deadlines and schedules and reputed company answers and guidance to audit questions. • Work closely with other departments resolving questions or discrepancies. • Assist in cross-training Level 1 auditors • Coordinate and respond to urgent audit inquiries through department proxy boxes. Level 3 • Can reputed company reputed company job functions of a Level 2 auditor • Review/audit claims reputed company to reputed company checks • Audit claims, inquiries, and enrollment reputed company to Medicare Advantage • Audit pending high-dollar member-pay claims over $7,000 • Initiate LOA's for pending high-dollar claims paying to subscriber over $7,000 • Answer questions without Supervisor input/reputed company. • Complete LDLA audits. • reputed company specialized audits, including on-site audits and external audits • Research cause and effect of errors and work with personnel in reputed company departments to resolve issues. • Cross-train reputed company 1-2 auditors Level 4 • Can reputed company reputed company job functions of a Level 3 auditor • Extensive knowledge of FEP and MTM manuals • Identify trends and gaps in audit findings • Can reputed company non-biased audits on QC auditor's work • Serve as backup for peer review of quarterly FEP reporting and semi-annual MTM reporting. • Assist with coaching and development of staff, including the cross-training of reputed company 1-3 auditors and auditor questions • Can batch workload appropriately and manage workload according to reputed company deadlines • Reconcile completed work with reports, financials, and findings for management and Reporting Analyst reputed company reputed company • reputed company reputed company level includes the ability to reputed company the essential functions of any reputed company reputed company and assist / mentor employees in those reputed company. • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. • reputed company reputed company other duties as assigned. REQUIRED COMPETENCIES Required Job Skills (Applies to reputed company reputed company) • Intermediate reputed company in use of office equipment, including copiers, fax machines, reputed company and telephones • Intermediate PC proficiency • Intermediate proficiency in spreadsheet, database and word processing software • Requires the ability to work with a reputed company of systems, including, but not limited to, MetaVance, TPS, FEPDirect, ITS, PlanConnexion, Blue 2, Image Retriever, Insurix, TI Portal, Tealeaf, Document Center, and VAT. Required reputed company Competencies (Applies to reputed company reputed company) • Analytical skills to support independent and effective reputed company • Prioritize tasks and work with multiple priorities, sometimes under limited time constraints. • Perserverance in the face of resistance or setbacks. • Effective interpersonal skills and ability to maintain reputed company working relationship with others. • Verbal and written communication skills and the ability to reputed company professionally with a diverse group, executives, managers, and subject matter experts. • Ability to interpret system applications and understand reputed company processing, system, and benefit configurations and changes • Working knowledge of HIPAA and reputed company requirements • Maintain confidentiality and reputed company • Analytical knowledge necessary to generate reports based on available data and then reputed company reputed company based on reported data Required Leadership Experience and Competencies (Applies to reputed company reputed company) • N/A PREFERRED COMPETENCIES Preferred Job Skills (Applies to reputed company reputed company) • Advanced reputed company in use of office equipment, including copiers, fax machines, reputed company and telephones • Advanced PC proficiency • Advanced proficiency in spreadsheet, database and word processing software Preferred reputed company Competencies (Applies to reputed company reputed company) • reputed company to meet customer needs • Work with ambiguous and conflicting information while keeping reputed company on the end goal. Preferred Leadership Experience and Competencies (Applies to reputed company reputed company) • N/A Our Commitment AZ Blue does not discriminate in hiring or employment on the reputed company of race, ethnicity, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, disability, protected veteran status or any other protected group. Thank you for your interest in reputed company. For more information on reputed company, see azblue.com. If interested in this position, please apply. Apply tot his job Apply To this Job