• Amerihealth Caritas Health Plan
  • Philadelphia , PA
  • Non-Executive Management
  • Full-Time
  • 1103 Market St


Under the direct supervision of the Supervisor, Manager and/or Director of Operations Quality Auditing, the Quality Auditing Team Lead supports the oversight and daily operation of the Quality Auditing Department. Leads multiple simultaneous Performance Management, Compliance and Operational audits to review and assess quality standards of AmeriHealth Caritas. Completes special projects and analyses.

Responsibilities include but not limited to:

* Demonstrates a thorough knowledge of business rules, requirements, policies and procedures relating to the implementation of all Quality Auditing functions across multiple lines of business. Ability to express this expertise in both written and verbal form.
* Understanding of metrics and methodology of all audits, i.e. Compliance, Enterprise Operations, Pre-Production, Performance Management, Target, etc.
* Manages the appeals process. Assists in evaluating and documentation/tracking for the Quality Auditing appeal process - responsible for decision making and guidance for appeal resolution through all levels of appeals.
* Identify the need and/or participates and assists in the development of all necessary protocols, policies and procedures, operational strategies and plans to develop and implement Quality Auditing programs.
* Identifies system and/or operational issues hindering the attainment of quality performance standards as defined by AMFC policy and associated business rules. Provides issue identification, problem analysis and strategies for resolution and/or implementation to Management.
* Responsible to coordinate inventory, tasks and projects within the time frame established in a professional manner
* Communicate with the quality auditing teams, in a professional manner, to ensure proper accuracy and all appropriate timelines are met. Provides coaching and feedback to associates as necessary
* Represent quality auditing in meetings as required.
* Provide accurate and timely response to inquiries regarding audits, appeals and/or projects
* Performs other related duties and projects as assigned


* 1-3 years Internal Quality Auditing Experience required.
* 3-5 years HealthCare experience required.
* Bachelor's Degree or equivalent experience.
* Competency in Microsoft Office software (Word, Excel, PowerPoint) required, Access is a plus.

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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