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Quality Review and Audit Senior Representative
Ref No.: 19-07431
Location: Phoenix, Arizona
Quality Review and Audit Senior Representative
Location: Remote, but 1 day a week on-site
Training Address: 25600 North Norterra Parkway, Building A, Phoenix, AZ 85085
Hours: Monday-Friday and some weekends/holidays as necessary - shift is flexible starting as early as 6:30AM-6:00PM Time off not permitted late in December and through January 2020
Pay Rate: $21.59/hour paid every Friday
Contract Length: 12/03/2019 to 05/02/2020 (possible extension based on attendance and performance)
Openings: 3
  • Delivers specific delegated Quality Assurance/Audit tasks assigned by a supervisor. Completes day-to-day Quality Review and Audit tasks without immediate supervision, but has ready access to advice from more experienced team members.
  • Identifies and recommends changes to improvements in department processing and procedures, and assists in the development of audit guidelines.
  • Requires seasoned knowledge of accounting and auditing procedures and systems expertise for auditing structure or claim payments.
  • Tasks involve a degree of forward planning and anticipation of needs/issues.
  • Resolves non-routine issues escalated from more junior team members.
  • Knowledge of CMS guidance of MAPD, Part D plans, and Medicaid
  • Working knowledge of Microsoft Word & Access, SharePoint, and Lync, with intermediate proficiency level of Excel.
  • Experience in quality review/auditing
  • Skilled in analyzing quality results
  • Proven confidence in the usage and application of all tools, workflows, and processes in current role
  • Minimum 3 years’ experience in a managed care or related field
  • Exceptional verbal and written communication skills
  • Work independently and with the team with minimal oversight and supervision
  • Ability to meet strict timelines
  • Strong interpersonal skills to work with many different personalities and styles
  • Capable of explaining complex issues in a concise manner
  • Detail oriented, Self-Starter, and Team Player
  • May need to travel 10% or less as required for position
  • High School Diploma or GED Required
  • Ability to pass 7-year county background check and urine drug screen
  • 2-4 year College degree preferred
  • CPhT preferred
  • AZ State Board of Pharmacy Certification preferred
  • At least 3 years of pharmacy claims experience in a managed care setting required
  • Knowledge of Medicare and Medicaid guidelines required