Advocacy Operations Auditor
The Advocacy Operations Auditor is a vital role in ensuring service excellence to Payer Compass clients and their members. The Auditor is responsible for auditing and monitoring trends and performing analyses. The auditor will evaluate results of audits, call history and recordings to identify potential issues, reoccurring errors, and patterns that may require refresher training or development of training materials. All audits and call monitoring will be completed using approved policies and procedures, and system design and technical documentation for all Payer Compass systems and product offerings. This role is also responsible to ensure Third Party compliance with Payer Compass policies, procedures, and protocols.
Payer Compass operates within multiple proprietary systems and multiple product offerings. This includes Avedon, Visium™, Compass Connect, and Innovate360. The Advocacy Operations Auditor will support systems design, test implementations, system migration, and new product offerings as needed.
ESSENTIAL JOB FUNCTIONS:
The Advocacy Operations Auditor will become a Subject Matter Expert (SME) in all Payer Compass’s systems and product offerings.
Responsibility for procedural and systems audits of completed member and provider records for advocacy requests (contacts) and balance bill support (events).
Partner with IT to assist with User Acceptance Testing (UAT) for system modifications and new system capabilities.
Assess audit tools, forms, and calculations as needed for new product offerings and system modifications.
Calculate individual, team, and department audit results from standard criteria, targeted audits, new hire audits, etc. Create and provide reports and statistics to leadership based on audit findings.
Collaborate with management and training team to identify and create training materials based on quality scores, client feedback, and product offerings.
Assist in development of standardized approach to implementation processes and training.
Identify opportunities and recommend methods to improve service, work processes, and financial performance.
Comply with HIPAA regulations and ensure confidentiality of calls, documents, and other sensitive information.
OTHER RESPONSIBILITIES AS ASSIGNED:
Special projects as assigned by the leadership team.
Miscellaneous office duties as assigned.
Back-up to other positions as assigned by the leadership team.
At least 12 months performance in the Advocacy Operations Senior Advocate, Advocacy Operations Team Lead, or other equivalent Payer Compass role with an Exceeds Expectation or higher performance rating, satisfactory attendance, or
High School diploma or equivalent, Associate or Bachelor’s degree preferred but not required, with a minimum of 1 years of experience working in the Healthcare/Insurance Industry as an auditor, and
Excellent communication skills, both verbal and written.
Excellent customer service skills.
Ability to maintain professionalism, decorum, tack, and diplomacy even during tense situations.
Demonstrated job stability.
MS Office proficiency, especially Excel.
Ability to use standard office equipment, faxes, copiers, etc.
THIS POSITION IS IDEAL FOR SOMEONE WHO IS:
Adaptable/flexible -- enjoys doing work that requires frequent shifts in direction.
Detail-oriented -- would rather focus on the details of work than the bigger picture.
Enjoys teaching or mentoring others.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Fingering: Picking, pinching, typing or otherwise working primarily with fingers rather than with whole hand or arm, as in handling. Speaking: Expressing or exchanging ideas by means of spoken word. Those activities in which require detailed or important spoken instructions must be conveyed to other workers accurately and quickly. Hearing: Ability to receive detailed information through oral communication with or without correction. Repetitive Motion: Substantial movement (motions) of the wrist, hands, and fingers.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Normal office environment with controlled temperature. The noise level in the work environment is usually moderate.
POTENTIAL CAREER PROGRESSION FOR THIS POSITION INCLUDE:
Advocacy Operations Trainer (lateral)
Advocacy Operations Supervisor
Advocacy Operations Manager
As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.
Commitment to Diversity, Equity, Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com
SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.