Quality non-calls Professional 2/ Quality Audit/GampA FULLY BILINGUAL English/Spanish Remote anywhere with Easter Time Zone

Profile

Job Information
Humana
Quality (non-calls) Professional 2/ Quality Audit/G&A (FULLY BILINGUAL English/Spanish) Remote, anywhere with Easter Time Zone
in
Indianapolis
Indiana
Description
The Quality (Non-Calls) Professional 2 ensures that products meet certain 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 (Non-Calls) Professional 2 audits quality of letter, keyed entries from billing and enrollment data.
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 and providers.
Reviews case documentation to assess appropriate system entries have been thoroughly completed to mitigate risk associated with external audit reviews and ensure the highest level of quality.
Responsible for driving accuracy, quality assurance, and compliance to all established policies and procedures, as well as sound documentation for all activities.
Serve as a subject matter expert and make process recommendations.
Follows established guidelines/procedures.
Required Qualifications
1 years of Grievance & Appeals and/or Auditing experience in the Healthcare Industry
Excellent computer skills and ability to easily navigate multiple applications
Ability to work independently under general instructions and with a team
Fully Bilingual English/Spanish
. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testing.
Work at Home Requirements
: Must have a room in your home designated as a home office; away from high traffic areas where confidential information may be secured. Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
Preferred Qualifications
Bachelor's degree
Experience with Medicare and Medicaid
Additional Information:
Schedule:
Monday through Friday between the hours of 8:00 AM-5:00 PM ET. Occasional Overtime to meet business needs.
Training
: If the associate is internal and has G&A knowledge, then training can be about 1-2 months. Otherwise the training period can be 2-3 months. This includes on-the-job training.
Work Location (Address)
: Remote (Anywhere with Easter Time Zone)
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.
COVID VACCINATION
: For this job, associates are required to be fully COVID vaccinated 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 or commit to testing protocols OR  
Provide proof of applicable exemption including any required supporting documentation
​​Note: Medical, religious, state and remote-only work exemptions are available.
Scheduled Weekly Hours
40

Company info

Sign Up Now - BilingualCrossing.com