Cincinnati, OH, United States
Audit, Quality, Healthcare, Bilingual
May 30, 2023
Bilingual Quality Auditor
The Bilingual Quality Auditor/ Professional 2 ensures that products meet specific Centers for Medicaid and Medicare Services standards of quality. Review worked cases from start to finish to ensure accuracy.
Bilingual Quality Auditor/ Professional 2
Analyze Grievance/Appeals case information to ensure compliance of all CMS regulations and contractual guidelines.
Responsible for the review of resolution communications provided to members.
Reviews case documentation to assess appropriate system entries have been thoroughly completed to mitigate risk associated with external audit reviews.
Responsible for driving accuracy and quality assurance, compliance to all established policies and procedures.
1 or more years of Grievance & Appeals and/or Auditing experience in the Healthcare Industry
Experience in a production goal-oriented environment within healthcare
Fully Bilingual English/Spanish -
Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testing.
Experience working with CSIM
Experience working with Microsoft Word, Excel & PowerPoint
Monday through Friday between the hours of 8:00 AM-5:00 PM ET. Occasional Overtime to meet business needs.
: If the associate is internal and has G&A knowledge, then training can be about 1-2 months. Otherwise the training period can be 2-3 months. This includes on-the-job training.
: Remote (Eastern Time Zone)
Language Proficiency Testing:
Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/yammer and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
Scheduled Weekly Hours
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Website : http://www.humana.com