Job Details

Under the general direction of the Manager, Performance Audit, the Performance Auditor is responsible for the completion of Quality Audits / Reviews within the Health Partners Plans Organization. This particular position will plan and conduct operational audits to support the Enrollment department. The Performance Auditor is expected to have experience and demonstrate proficiency in performing quality assurance audits/reviews, which conform to professional audit standards. The Performance Auditor will assist the Sr. Performance Auditor with planning, development of audit programs for audit testing and evaluation, and reporting of audit results. The complexity and size of audit assignments varies.

Job Description

• Executes a wide variety of audit tests/procedures and accurately interprets results against defined criteria.
• Understands the operational and compliance risks that affect HPP’s Operations; demonstrates the ability to identify and appropriately measure those risks; and formulates recommendations that are appropriate, practical, and cost-effective.
• Consistently documents relevant facts and information to support the work performed and conclusions drawn so operations representatives can follow the auditor's logic and methodology.
• Effectively evaluates audit results, weighing the relevancy, accuracy, and perspective of conclusions against the accumulated audit evidence.
• Effectively communicates audit results, both verbally and in writing, so they are clear and concise, placed in the appropriate context, and understood by the recipient.
• Conducts audits in accordance with professional and departmental standards.
• Knows when to seek guidance from supervising staff as circumstances warrant.
• Completes work assignments independently or as part of a team project.
• Interacts effectively with others in a professional manner.
• Demonstrates effective time management skills by completing assignments within assigned timeframes.
• Exhibits creativity and innovation in recommending improvements to departmental audit practices and processes.

Education and Experience:

• Associate’s Degree from an accredited university / college in a relevant course of study or
• High School Diploma/GED in the absence of college coursework, at least two years in managed care or health insurance customer service, audit or quality assurance experience with a minimum of 4 years proficiency in a health insurance operational function will be considered
• Working knowledge of current Applications and Core Systems that support the Enrollment business unit.
• Outstanding analytical, interpersonal, and written communication skills.
• Ability to communicate effectively.
• Medical Terminology
• working knowledge of HIPAA, and other related regulations
• MS Office skills.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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Executes a wide variety of audit tests/procedures and accurately interprets results against defined criteria. Understands the operational and compliance risks that affect HPP’s Operations; demonstrates the ability to identify and appropriately measure those risks; and formulates recommendations that are appropriate, practical, and cost-effective. Consistently documents relevant facts and information to support the work performed and conclusions drawn so operations representatives can follow the auditor's logic and methodology. Effectively evaluates audit results, weighing the relevancy, accuracy, and perspective of conclusions against the accumulated audit evidence. Effectively communicates audit results, both verbally and in writing, so they are clear and concise, placed in the appropriate context, and understood by the recipient. Conducts audits in accordance with professional and departmental standards. Knows when to seek guidance from supervising staff as circumstances warrant. Completes work assignments independently or as part of a team project. Interacts effectively with others in a professional manner. Demonstrates effective time management skills by completing assignments within assigned timeframes. Exhibits creativity and innovation in recommending improvements to departmental audit practices and processes. Education and Experience:Associate’s Degree from an accredited university / college in a relevant course of study or. High School Diploma/ GED in the absence of college coursework, at least two years in managed care or health insurance customer service, audit or quality assurance experience with a minimum of 4 years proficiency in a health insurance operational function will be considered. Working knowledge of current Applications and Core Systems that support the Enrollment business unit. Outstanding analytical, interpersonal, and written communication skills. Ability to communicate effectively. Medical Terminologyworking knowledge of HIPAA, and other related regulations. MS Office skills. Work Shift. Workday Day (United States of America)Worker Sub Type. Regular. Employee Entity. Health Partners Plans, Inc. Primary Location Address 1101 Market, Philadelphia, Pennsylvania, United States of America.

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