The purpose of the Quality Assurance Coordinator is to design and implement a quality assurance program for all systems and locations at Cypress Benefit Administrators. Creation and ongoing maintenance of communication tools and reports to best enhance audit production, client satisfaction, analyst feedback, and quality assurance.
Essential duties and responsibilities
Report to work on a consistent, regular basis
Audit targeted quantity of professional, facility, and dental claims to identify examiner
and system errors, as well as research and resolve the identified errors
Audit specific claims for clients in conjunction with performance guarantees.
Assist in auditing of client specific issues and identification of adjustments that may need
to be completed.
Objectively investigate claim data and/or claim records to identify payment errors.
Work closely with Training to identify guidelines or resources that need to be
created/updated for staff
Analyze and validate audit findings according to applicable payer regulations, payer
processing guidelines, client SPD’s, and provider contracts. Provide feedback on gaps.
Maintain a record of audit results
Prepare and communicate results of audit reviews and performance issues to analysts and
management with a focus on continuous improvement initiatives
Identify and recommend corrective action plans and training or processes or resources to
meet accuracy requirements
Respond professionally and accurately to all client/provider inquiries and provide
technical support for claims, other Cypress departments, and partner vendors (i.e.
Perform other duties and special projects as assigned by management.
Understanding of Self-Funding and Third-Party Administrating concepts.
Expertise in insurance reimbursement/payment policies, audit reviews and analysis, medical/dental terminology, CPT coding, ICD-9 coding, dental coding.
Effective communication and presentation style (written and verbal).
Ability to meet production goals and deadlines. Strong organizational skills; ability to multitask and set
priorities. Ability to solve problems and work independently as well as in a team
Self-direction and self-starter skills required. Previous experience in professional, institutional healthcare, and dental claims examining, as well as auditing experience desired.
Equal Employment Opportunity Policy Statement
Lucent Health Solutions, Inc. is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, gender identity, gender expression, transgender status, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.