DescriptionSHIFT: Day Job
Your Talent. Our Vision. At National Government Services (NGS), an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
SCA Quality Auditor I or II
The SCA Quality Auditor is responsible for examining and evaluating the accuracy of transactions in accordance with regulations and company guidelines.
Primary duties may include, but are not limited to:
- Identifies documents and reports any transaction errors in a timely manner to ensure prompt resolution.
- Applies expert knowledge in most areas.
- Able to perform simple functions; works under general direction.
- Examines and evaluates on a prepayment basis the accuracy of transactions processed by reviewing policy, procedure and manual input in accordance with guidelines.
- Tracks and trends audit results, providing feedback to management.
- Generates monthly reports of audit findings, supports clients with issued identified, develops reports to assist management with information requested.
- Produces other ad hoc reports as requested by internal and external clients.
- Requires H.S. diploma or equivalent;
- Level I: 9 months to 1 year related experience;
- Level II: 2 to 3 years related experience; A.S. degree preferred. SME in at least one operational area.
- Or, any combination of education and experience, which would provide an equivalent background.
- A working knowledge of the Medicare program is required
- Experience processing Provider enrollment applications is preferred
- Medicare and Medicaid processing experience; claims, appeals, etc.
- PECOS, FISS, and/or MCS platform experience/ working knowledge
- Auditing of operational transactions experience
- Intermediate to advanced MS Office experience
- Navigating through SharePoint experience
- Strong verbal and written communication skills is required
- Must be able to work in a fast paced/ high volume environment
Non-negotiable hourly rate for this position by location.
South Portland, ME
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
At Anthem, Inc., we believe that our health connects us all. So we focus on being a valued health partner and delivering quality products and services that give members access to the care they need. With more than 100 million people served by our affiliated companies including approximately 40 million enrolled in our family of health plans, we can make a real difference to meet the needs of our diverse customers.
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