Senior QA Specialist, Client Support
JSR Micro, Inc.
ERP
NCQA Accreditation Analyst
BlueCross BlueShield of South Carolina
full-time
Posted on:
Location Type: Hybrid
Location: North Carolina, South Carolina • 🇺🇸 United States
Visit company websiteSalary
💰 $49,447 - $94,737 per year
Job Level
Mid-LevelSenior
About the role
- Lead accreditation compliance activities including review and interpretation of the standards
- Monitor multiple areas' compliance
- Develop and implement quality improvement activities to improve compliance
- Maintain full three-year accreditation status and monitor NCQA processes/standards
- Conduct/participate in audits of areas to ensure compliance with NCQA activities
- Analyze audit results and make recommendations for improvements
- Prepare formal documentation of audits
- Present findings to relevant committees and monitor corrective action plans
- Provide HEDIS support for multiple departments
- Coordinate preparation of on-site audits conducted by external bodies
- Review medical records for coding validations
Requirements
- Bachelor's in a job related field
- 5 years of health insurance industry, audit/compliance/investigations, project management, or corporate level related experience
- If Master’s degree, required work experience is 3 years
- Ability to effectively communicate both verbal and in writing to all levels of the organization
- Knowledge/understanding of medical terminology and medical coding
- Excellent analytical or critical thinking and problem solving skills
- Ability to make sound decisions and work independently
- Ability to exercise confidentiality and discretion
- Excellent presentation skills with strong attention to detail
- Microsoft Office skills
Benefits
- Subsidized health plans
- Dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
accreditation compliancequality improvementaudit analysismedical codingHEDIS supportcompliance monitoringdocumentation preparationdata analysisproject management
Soft skills
effective communicationanalytical thinkingproblem solvingdecision makingconfidentialityattention to detailindependencepresentation skills
