Quality Auditor Jobs in Oklahoma

JOB SUMMARY:

Responsible for completing out-bound calls and other member outreach opportunities to select members and documenting efforts. This role spends 100% of time on quality program activities. May require extended, or multiple, phone calls to members. May require work on additional projects as directed.

KEY RESPONSIBILITIES:

• Contact members selected for intervention. Assist members with developing a plan to resolve identified HEDIS gaps in care, setting up appointments, getting to and from appointments, sharing information on external resources such as Human Services and community services, and encouraging effective self-management behaviors. Refer members with specific clinically-related questions to supervisor, or Clinical Healthcare Coordinator and/or to Member Services to address other requests.
• Compile results of work for analysis and trending. Share potential opportunities for improvement with supervisor based on interaction with members.
• Organize call list and related activities for effective use of time.
• Assist with development of call campaigns, call scripts and other outreach opportunities (for example mobile apps, text messaging, etc). Interventions are customized by objective and member demographics to close identified HEDIS gaps in care and achieve other QI Project objectives.
• Perform other duties as assigned, including but not limited to project planning and collaboration with other QI Department staff on other outreach opportunities (mailings, web-based outreach or on-site events, etc).

QUALIFICATIONS:

• Knowledge of HMO plans, enrollment, benefits, and claims.
• Demonstrated ability to relate and interact effectively with all types of individuals.
• Highly organized and attentive to detail.
• Proficient in Microsoft applications.
• Excellent problem solving skills.
• Bilingual preferred.
• Possess strong oral and written communication skills.
• Successful completion of Health Care Sanctions background.

EDUCATION/EXPERIENCE:

• High school diploma or equivalent. Bachelor's degree in English, Communications, Social Science, Marketing, Business or similar preferred.
• Experience working with elderly or geriatrics preferred.
• Experience with "face to face" customer experience.
• Three years previous customer service experience. Managed healthcare, insurance industry, or medical office/clinic preferred.
• Prior claims examining experience preferred.
• Cross trained and functional on three or more lines of business.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin.