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QA Financial Auditor-100% Remote

  • Anywhere
  • Anywhere

Healthfirst

Healthfirst provides health insurance at little to no cost to eligible children, adults, and families in NYC.

The Quality Assurance Financial Auditor is responsible for performing Quality Assurance Audits of financial processes completed by internal employees and outsourced vendors to ensure compliance with policies, procedures, and quality standards to mitigate financial risk. The incumbent investigates, audits, conducts root cause analysis, handles processing of determinations, and tracks/trends findings under minimal supervision.

  • Conduct routine and moderately complex quality audits inclusive but not limited to the following:
  • Pre/Post payment provider claims utilizing appropriate sources of information including eligibility, enrollment, state contracts, provider and facility contracts, and state and health plan billing manuals
  • Financial-related operational processes such as electronic fund transfer (EFT), member billing, accounts receivable, etc.
  • Claim and appeal requests including processing (where applicable), tracking, documenting, reporting and dispersal of findings and recommendations
  • Identify trends, issues, exceptions, and provide feedback to appropriate leaders of financial-related work.
  • Confirm employee adherence to company, state and federal policies and procedures including compliance and regulatory guidelines
  • Analyze errors and determine root causes for appropriate classification
  • Record/track quality assessment scores and provide feedback to reduce errors and improve processes and performance to ensure the quality of the network
  • Review and investigate claims and encounters for medical, facility, pharmacy, dental and vision services including contractual provisions, authorizations and Healthfirst policy and procedure
  • Prepare written reports concerning investigation activities and present results of investigations to senior staff
  • Identify quality, operational efficiency, and production goal defects to support the improvement of departmental performance
  • Identify patterns, trends and variances related to audited performance
  • Assist in the development of departmental policies and procedures
  • Review the accuracy and efficiency of existing training materials
  • Meet established time frames and rates of performance for both quality and quantity of work
  • Comply with HIPAA guidelines and maintain confidentiality of employee, member, provider, medical and departmental information

Minimum Qualifications:

  • Claims processing or equivalent financial processing experience
  • Work experience in Microsoft Office suite of applications including Excel (which includes formatting formulas, managing data, and filtering results), Word, PowerPoint, and Outlook
  • Experience conducting analytical work and providing creative ideas for problem solving
  • Work experience requiring written and verbal communication that is clear, concise, grammatically correct, and professional
  • High School Diploma or GED from an accredited institution

Preferred Qualifications:

  • Associate degree or higher
  • Auditing of financial processes including investigation, determination, and reporting
  • Experience handling Personal Health Information (PHI) in a professional manner
  • Ability and willingness to handle increasing workload and responsibility
  • Willingness and ability to learn and evaluate new information, both technical and procedural
  • ICD10 certification
  • Knowledge of at least two or more lines of business such as NY Medicare, Medicaid, Family Health Plus, Child Health Plus, etc.

Minimum Qualifications:

  • Audit experience including investigation, determination, and reporting
  • Work experience in Microsoft Office suite of applications including Excel (which includes formatting formulas, managing data, and filtering results), Word, PowerPoint, and Outlook
  • Experience conducting analytical work and providing creative ideas for problem solving
  • Work experience requiring written and verbal communication that is clear, concise, grammatically correct, and professional
  • High School Diploma or GED from an accredited institution

Preferred Qualifications:

  • Associate degree or higher
  • Auditing of financial processes
  • Experience handling Personal Health Information (PHI) in a professional manner
  • Ability and willingness to handle increasing workload and responsibility
  • Willingness and ability to learn and evaluate new information, both technical and procedural
  • ICD10 certification
  • Experience in an Auditing capacity where you have conducted root cause analysis
  • Knowledge of at least two or more lines of business such as NY Medicare, Medicaid, Family Health Plus, Child Health Plus, etc.

Compliance & Regulatory Responsibilities: See Above

License/Certification: N/A

Please note: Since we care so greatly about our employees’ and members’ wellbeing, Healthfirst is moving to an environment where our employees are fully vaccinated against COVID-19. As a prospective new team member, you must be fully vaccinated with a CDC/FDA approved COVID-19 shot(s) to work in our offices. If you are selected to interview for this role, we will explain our vaccination policy in further detail and ensure you are comfortable moving forward with this company policy.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

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QA Financial Auditor-100% Remote

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Healthfirst

Healthfirst provides health insurance at little to no cost to eligible children, adults, and families in NYC.

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