• Direct the global technical governance of the TISAX product • Maintain, further develop and assure the quality of TISAX processes in accordance with ENX and Scheme requirements • Provide global support to regions for execution, interpretation and problem resolution • Develop and deliver training for assessors and relevant stakeholders • Act as primary contact for ENX, including coordination of reports, findings and workshops • Independently perform complex customer audits • Provide technical support for complex audit situations within the region • Contribute to strategic customer projects and tenders • Manage competence and perform technical calibration of auditors • Ensure compliance with global processes and accreditation requirements

• Planung, Durchführung und Nachbereitung von externen Kunden-Audits • normenkonforme Dokumentation im Rahmen der Akkreditierungsvorgaben und internen Regularien • Erstellung von Auditberichten • Weiterentwicklung zum Lead Auditor in weiteren Standards

• Reviewing prescriptions to ensure accuracy • Sending prescriptions to the pharmacy to be processed • Reviewing EHR to ensure all necessary information is recorded • Reviewing lab order to ensure all lab orders are completed and recorded • Effective daily communication with contracted pharmacies • Swift and effective communication to correct any mistakes • Schedule Audits • Prescription Audits • Handle medication recalls appropriately • Ensuring payments are handled properly • Handling a high volume of charts

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Serves as an entry level professional who develops baseline plans for ensuring the integrity and accuracy of claims processes and protocols. Collects data for audits/investigations into claims, utilizing a combination of analytical skills and attention to detail, reviewing documentation, interviewing involved parties, and communicating with various stakeholders to gather relevant information for successful resolution and closure. Identifies opportunities to target fraud, waste, and abuse or discrepancies in claims submissions. Adheres to industry regulations and company policies for managerial follow-up. Analyzes data in order to effectively assess the validity of claims. Provides accurate recommendations to management for claim resolution and closure. Documents and inputs all findings, while preparing comprehensive reports that may be used for legal or audit/investigative purposes. Qualifications - Minimum Bachelor's Degree required Requirements - 0 - 2 years of experience required; 2 - 4 years preferred - Healthcare fraud experience required; Medicare experience preferred Benefits - Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities. Essential Functions - Conducts routine and impartial audits/investigations into customer claims, ensuring accurate and fair assessments of claims validity. - Provides customer service by addressing inquiries and concerns, and escalates audit/investigation, as needed. - Compiles detailed and organized records of audit/investigation findings, ensuring accuracy and compliance with legal and regulatory requirements. - Applies functional knowledge to create and implement strategies to identify and prevent fraudulent activities, safeguarding the integrity of the claims process. - Conducts interviews with relevant witnesses, claimants, and other stakeholders to gather additional information and perspectives on claims. - Communicates with appropriate internal teams to ensure the proper processing of audits/investigations, while adhering to legal and regulatory standards. - Ensures that all audit and investigative documents and records are processed into the database in a timely and accurate manner. - Communicates audit/investigation findings clearly and professionally to customers, claimants, and other stakeholders, managing expectations and providing updates. - Supports management in regular audit and investigation proceedings, ensuring full compliance with all applicable regional and federal standards, regulations, and protocols. Level of Supervision Received Under general supervision, proceeds alone on regular duties, referring questionable cases to manager. Certification(s) - Certified Fraud Examiner or Accredited Healthcare Anti-Fraud Investigator preferred