About Texas Children's HospitalFounded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org. Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
We are searching for a Quality Auditor-- someone who works well in a fast-paced setting. In this position, you will be responsible for reviewing and evaluating the quality and effectiveness of the department policies and procedures, processes, and system updates such as member eligibility, provider setup, benefit/contract/edit configuration, and/or code/rate updates. This role will partner with the department managers on audit findings to ensure identified errors are promptly and appropriately corrected, as well as identified performance and/or training gaps are addressed. The Quality Audit also tracks and reports quality metrics for the department and serves as the department's point of contact for audit inquiries.
Think you’ve got what it takes?
Job Duties & Responsibilities
Skills & Requirements