Elevance Health Quality/Training Specialist I in Springfield, Illinois
Quality/Training Specialist I
Job Family: Customer Care
Type: Full time
Date Posted:Jul 28, 2022
Req #: JR1424
North Carolina, North Carolina
South Carolina, South Carolina
New Jersey, New Jersey
New York, New York
Responsible for conducting quality audits based on the Fair Business Practice Act, MCHIP, NCQA, HIPAA, and BCA guidelines.
Primary duties may include, but are not limited to:
Determines the impact of new federal or state regulations on provider files.
Develops and maintains departmental policies and procedures.
Reviews, evaluates, and verifies the quality of provider files against predetermined measures and provides feedback to associates accordingly.
Assures internal and external guidelines are followed to the fullest extent.
Tracks and trends provider file errors and determines mechanism for corrective action.
Compiles and reports quality audit results to various internal departments as required.
Conducts in-house training as needed.
Requires HS diploma or GED; 2 years of provider file systems experience; or any combination of education and experience, which would provide an equivalent background.
Previous auditing or training experience preferred. BA/BS degree preferred.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.
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