Duties / Responsibilities:
* Responsible for peer evaluations of in process Medicaid applications, for accuracy in accordance with Federal and State regulations and departmental approved Policies and Procedures.
* Responsible for entering and submitting error findings using department specific Quality Control tools.
* Complete the follow up process for all inaccurate applications tasks reviewed.
* Provide feedback to Quality Control Supervisor(s) giving specific reasons for variances and respond to dispute findings when necessary.
* Complete task processing for all application and verification documents received.
* Meet all performance requirements associated with the quality control processes.
* Exceptional content knowledge of current policies and procedures.
* Determines best path for document problem resolution and escalates tasks to Research, when necessary.
* Perform other duties as assigned by management.
Education / Experience:
* High School diploma or equivalent with 2-4 years of experience.
* May have additional training or education in area of specialization.
* Works on assignments that are semi-routine in nature but recognizes the need for occasional deviation from accepted practice.
* Communicates more complex information, using job experience to anticipate and proactively address related questions.
* Excellent organizational, interpersonal, and communication skills.
Guidant Global (BH4SF) is acting as an Employment Business in relation to this vacancy.
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