Job Details

Quality Audit Professional 2 Grievance amp Appeals -FULLY BILINGUAL English/Spanish Remote anywhere with-in Eastern Time Zone

Location
Indianapolis, IN, United States

Posted on
Jun 29, 2022

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Job Information
Humana
Quality Audit Professional 2 (Grievance & Appeals) -(FULLY BILINGUAL English/Spanish) Remote, anywhere with-in Eastern Time Zone
in
Indianapolis
Indiana
Description
The Quality (Non-Calls) Professional 2 ensures that products meet specific Centers for Medicaid and Medicare Services standards of quality. The Quality (Non-Calls) Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities
The Quality Audit Professional 2 audits quality of letter, keyed entries from billing and enrollment data.
Must be bilingual English/Spanish with ability to speak read and write in both languages without limitations or assistance.
Analyze Grievance/Appeals case information to ensure compliance of all CMS regulations and contractual guidelines.
Responsible for the review of written communication provided to members
Reviews case documentation to assess appropriate system entries have been thoroughly completed to mitigate risk associated with external audit reviews.
Responsible for driving accuracy and quality assurance, compliance to all established policies and procedures, and sound documentation for all activities.
Serve as a subject matter expert and make process recommendations.
Checks quality cases built by other associates to ensure highest level of quality.
Follows established guidelines/procedures.
Required Qualifications
2 years of Grievances & Appeals or Auditing experience in the Healthcare industry
Must be bilingual English/Spanish with ability to speak read and write in both languages without limitations or assistance.
Strong writing skills- written assessment in both English and Spanish must be passed before a interview is conducted
Experience in the Healthcare industry or Medical field (Production Goal oriented environment)
Experience with Medicare and Medicaid
Excellent computer skills and ability to easily navigate multiple applications
Ability to work independently under general instructions and with a team
Work-At-Home Requirements:
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
COVID Requirements
: For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster or commit to testing protocols
*OR  *
Provide proof of applicable exemption including any required supporting documentation
​​ Medical, religious, state and remote-only work exemptions are available.
Preferred Qualifications
Bachelor's degree
Additional Information
Schedule
: Must be able to work Monday - Friday 8:00 am - 5:00 pm. Flexible with your hours based on business needs to work possible overtime.
Language Proficiency Testing:
Any Humana associate who speaks with a member in a language other than Spanish and/or English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
Work Location (Address)
: Remote (Anywhere with-in Eastern Time Zone)
Scheduled Weekly Hours
40

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