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Quality Assurance Auditor, Specialist

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: September 18, 2022

Job Description:

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to DE&I combines a focus on our people processes and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen. Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us Your Role The Pharmacy Quality team is responsible for the development, maintenance, and implementation of a continuous quality assurance program. The Quality Assurance Auditor, Specialist will report to the Pharmacy Infrastructure Supervisor. In this role you will routinely audit the quality of the Pharmacy Authorization Center technician team, interaction with BSC internal and external customers. This role also identifies training opportunities and knowledge gaps; assisting in the development and delivery of training modules, to support team achievement of required quality standards. Your Work In this role, you will: Be responsible for performing audits that are routine in nature where limited judgment is required Focus on single area of expertise or line of business (Claims, Inquiry, Enrollment); objectively review and interpret standards, procedural documentation and contract and legal verbiage Identify and document audit observations and findings Notify Supervisor when communications with operations are necessary; coordinate appropriate messaging Identify and resolve routine problems independently; escalate issues with Supervisor as appropriate Develop, document, and maintain desk level, policies & procedures, identifying and developing solutions for quality gap Calibrate across quality mentor teams to ensure consistency in application of quality program Provides input to the Learning & Performance Trainer in the development of training modules and performance action plans to resolve identified knowledge and quality gaps Meet individual production standards for completion of quality audits Perform other duties as assigned by the Management Team Your Knowledge and Experience Qualifications: Requires a high school diploma or GED Requires at least 7 years of prior relevant experience State Board Certified Pharmacy Technician license preferred Experience with demonstrated knowledge of managed health care pharmacy and the outpatient prescription benefit design Strong computer skills to operate effectively with company systems and programs knowledge of Microsoft office (Word, PowerPoint, Visio & Excel) Strong documentation and organizational skills Previous quality assurance experience, performance coaching or other leadership experience e.g., providing feedback and coaching or training to less skilled or less experienced personnel preferred Ability to work independently with limited supervision using established procedure Our Values Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes. Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. PDN-97425b20-6441-4989-bf1f-6ebe27d8384f

Keywords: Blue Shield of California, Rancho Cordova , Quality Assurance Auditor, Specialist, Accounting, Auditing , Rancho Cordova, California

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