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.

JOB REQUIREMENTS:

• 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:

• Dependable.

• 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.

PHYSICAL DEMANDS

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.

WORK ENVIRONMENT

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

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