Auditor, Quality Assurance

MVP Health Care is a nationally-recognized, regional not-for-profit health plan committed to having a positive impact on health and wellness of everyone we serve. With MVP, you are assured of quality health care and peace of mind—from a name you know and trust. We care for more than 700,000 members across New York and Vermont, creating healthier communities and continuing our 30-year legacy of quality and integrity.

Monitors and records the quality of work performed by Specialists within the Provider Data Management Department for accuracy of participating/non-participating provider record set up in Cactus and/or Facets. Identify trends of specific errors and error rates. Research, identify and corrects deficiencies related to work quality, work flow or specific quality issues. Develops, produces and presents periodic reports based on audits/projects completed, for the Provider Data Management Department. Determines and recommends needs for retraining or clarification of work procedures. Provides training to Specialists needing additional training to ensure accuracy and adherence to departmental policies and procedures. Updates departmental training and process documents as needed. Works with Corporate Compliance related to HIPAA violations caused by work performed by Specialists within the Department. Performs other duties as assigned.

Minimum Education: Associates degree in business-related field or equivalent combination of education and related experience. Minimum Experience: Minimum of 3 years proven track record of provider record creation/modification or claims processing/auditing experience consistently exceeding quality requirements. Required Skills: • Attention to detail and commitment to quality service. • Good written and verbal communication skills. • Proven organizational and analytic skills. • Ability to work independently and as part of a team. • Working experience with Facets and/or Cactus. • Working experience with MS Office (Excel, Word). Preferred Skills: • Previous Training or Quality Assurance experience.