Overview:
Now is the time to join us!
We’re Personify Health. We’re the first and only personalized health platform company to bring health, wellbeing, and navigation solutions together. Helping businesses optimize investments in their members while empowering people to meaningfully engage with their health. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.
Responsibilities:
Who are you?
Auditor/Trainer Non-Clinical will provide administrative support for the monitoring of utilization review (UR) compliance and fees. The associate will work closely with the UR manager, director, compliance, and account managers.
In this role you will wear many hats, but your knowledge will be essential in the following:
Level I:
Perform clerical/administrative duties in the utilization, chronic disease and case management departments.
Provide accurate information to internal and external customers, (reports, audits, data collection) as it relates to compliance for all local, state, federal, URAC and NCQA compliance.
Review service requests from internal and external customers respond accurately and timely.
Plan, organize and carry out work assignments timely and orderly.
Maintain folders for various projects organized for easy access for audits and accreditation.
Use appropriate judgment in upward communication regarding department or employee concerns.
Participate in Quality Committee (QIC) and routine meetings and maintain a current task, shared task list or current projects.
Ability to meet productivity, quality, and turnaround times daily.
Maintain HIPPA compliance per company’s policy and procedures.
Complete all required yearly training and testing per company’s expected timeframe.
Pulling invoices to confirm payment, if needed.
Level II:
Perform clerical/administrative duties in the utilization, chronic disease and case management departments.
Provide accurate information to internal and external customers, (reports, audits, data collection) as it relates to compliance for all local, state, federal, URAC and NCQA compliance.
Review service requests from internal and external customers respond accurately and timely.
Plan, organize and carry out work assignments timely and orderly.
Maintain folders for various projects organized for easy access for audits and accreditation.
Use appropriate judgment in upward communication regarding department or employee concerns.
Participate in Quality Committee (QIC) and routine meetings and maintain a current task, shared task list or current projects.
Ability to meet productivity, quality, and turnaround times daily.
Maintain HIPPA compliance per company’s policy and procedures.
Complete all required yearly training and testing per company’s expected timeframe.
Pulling invoices to confirm payment, if needed.
Additional requirements preferred: certification in audits, training, accreditation, and/or 10 years of experience that coincides with or greater than accreditation
Demonstrated organizational skills to participate in all audits at all levels.
Level III (Senior)
Perform clerical/administrative duties in the utilization, chronic disease and case management departments.
Provide accurate information to internal and external customers, (reports, audits, data collection) as it relates to compliance for all local, state, federal, URAC and NCQA compliance.
Review service requests from internal and external customers respond accurately and timely.
Plan, organize and carry out work assignments timely and orderly.
Maintain folders for various projects organized for easy access for audits and accreditation.
Use appropriate judgment in upward communication regarding department or employee concerns.
Participate in Quality Committee (QIC) and routine meetings and maintain a current task, shared task list or current projects.
Ability to meet productivity, quality, and turnaround times daily.
Maintain HIPPA compliance per company’s policy and procedures.
Complete all required yearly training and testing per company’s expected timeframe.
Pulling invoices to confirm payment, if needed.
Additional requirements preferred: certification in audits, training, accreditation, and/or 10 years of experience that coincides with or greater than accreditation
Demonstrated organizational skills to participate in all audits at all levels.
Additional requirements in certification for URA, NCQA or other qualifying certification equal to those listed.
10 years of experience that coincides with or greater than accreditation
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Qualifications:
What you bring to the Personify Health team:
In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:
High school graduation or equivalent (GED).
Bachelor's degree in business or equivalent preferred for level I and II
Required Bachelor's degree
Previous employment in an office type role or equivalent.
Previous medical experience in an office or insurance setting preferred
Previous audit and training experience, minimum 3 years experience
Strong written and verbal communication skills
Proficient in Microsoft Excel, Word, Power point, Publisher and Outlook
Advanced proficiency in Adobe Pro and SharePoint
Ability to organize, prioritize, and multitask in a fast-paced/deadline driven environment
Demonstrate ability to work independently with excellent judgment and able to accurately interpret and implement accreditation.
Accurate data entry skills (40wpm)
Excellent interpersonal and communication skills
Strong customer orientation and working through audits with multiple requirements
Understands working to the highest level to meet all requirements
Computer competencies in multiple screens and programs
No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!
Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.
In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges from $50,000 to $70,000. Note that salary may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.
We strive to cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive. Personify Health is committed to driving Diversity, Equity, Inclusion and Belonging (DEIB) for all stakeholders: employees (at each organization level), members, clients and the communities in which we operate. Diversity is core to who we are and critical to our work in health and wellbeing.
#WeAreHiring #PersonifyHealth
Beware of Hiring Scams: Personify Health will never ask for payment or sensitive personal information such as social security numbers during the hiring process. All official communication will come from a verified company email address. If you receive suspicious requests or communications, please report them to talent@virginpulse.com. All of our legitimate openings can be found on the Personify Health Career Site.
