Quality Auditor - RCM Back Office - All Sites

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

This position is responsible for Quality Assurance program activities by providing process and operational support to the functions within Business Operations. Positions in this function are responsible for performing quality reviews and providing feedback to their leaders that support continuous quality improvements. This role requires engagement and collaboration across LPS.

Primary Responsibilities:

• Be able to work independently and collaborate with team members across LPS
• Communicates with leadership for training when a knowledge gap is identified
• Acts upon leadership feedback of issues identified and develops action plan for solutions
• Supports QA solutions that serve the needs of operations in understanding review results and actions taken to resolve gaps in the process
• Effective in using relevant computer systems and software (EQT, Reporting Systems, OLC, operations systems, MS Office)
• Utilizes critical thinking skills to solve for issues
• Demonstrates an understanding of the organizations' operations, products and applications, strategies, processes, and/or business priorities for effective outcomes
• Collaborates with internal stakeholders with root cause findings and trends in process gaps to improve processes
• Acts as a resource to others on the team and department
• Detailed Responsibilities:

• Performs Quality reviews to validate process accuracy and input findings into EQT
• Logs daily productivity into EQT
• Communicates issues/gaps identified while performing daily activities
• Completes other tasks as assigned
• Solves moderately complex issues
• Actively participates in meetings
• Practices standard operating procedures, policies, and process knowledge of how they impact the business and operations
• Uses QA methodology when participating on projects that will improve the overall process for the department and operations
• Works with leader on potential solutions when issues are identified during QA review process

• Graduate education or equivalent experience
• Experience working with hospital and physician claims
• Experience in effective communications (verbal, written, and presentation) skills with the ability to communicate to a variety of management levels within the organization including leadership
• Knowledge in Revenue Cycle Management Backend
• Intermediate MS Office experiences including Word, Excel, and PowerPoint
• Proven analytical skills that will lead to aiding in process improvements within the department and operations
• Proven solid written and verbal communication skills
• This is a full-time onsite role; candidates must be flexible to work from the office as required (hybrid work is not available)

• 2+ years in a role supporting a quality assurance function or related operational function within Revenue Cycle Management
• Experience in large, multi-function and cross geographic organization
• Specific experience working in an Operations Environment
• Technical Tools: Understands relevant computer systems and software (i.e., Reporting Systems, Operations systems, MS Office)