Quality Control Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct comprehensive functional pre- and post-transaction outcome assessments to evaluate transaction accuracy and adherence to compliance standards.

• Remain informed about anticipated operational outcomes.

• Ensure quality assessments align with relevant processes, contractual service-level agreements, and compliance regulations.

• Choose audits based on random selection and/or other established criteria.

• Execute random and/or focused periodic quality audits.

• Accurately document the results of each quality audit.

• Assist in identifying compliance risks, performing root cause analyses, and outlining corrective action measures.

• Provide feedback to operational delivery teams to address identified findings.

• Work collaboratively with operations on ongoing quality improvement initiatives.

• Suggest enhancements to quality, workflow processes, policies, and procedures.

• Contribute both independently and as part of a team on moderately complex project assignments.

⛳️ Requirements

• Generally requires an associate degree.

• A minimum of 2 years' experience in the healthcare industry, specifically within the payer segment in Medicare Advantage, Managed Medicaid, or with a competitor in the industry.

• Proven experience in conducting and documenting quality assessments of healthcare transactions.

• Familiarity with coding accuracy, benefit payment, contract interpretation, and adherence to policies and procedures.

• Proficiency in MS PowerPoint, MS Word, MS Excel, and MS Access.

• Strong attention to detail with the ability to perform under tight deadlines.

• Outstanding interpersonal, listening, written, and verbal communication skills.

• Capable of adhering to company security and privacy policies as well as relevant laws and regulations, including HIPAA and HITECH.

• Competent in securely protecting PHI and PII.

• Experience in a BPaas environment is advantageous.

• Background in reviewing system configurations is a plus.

🏝️ Benefits

• Fully remote work culture.

• Comprehensive health, dental, and vision insurance.

• Five weeks of vacation plus holiday pay.

• Traditional and ROTH 401k plans with company matching.

• Company-sponsored life insurance, AD&D, and long-term disability coverage.

• Health Savings Account (HSA) and Flexible Spending Account (FSA) options.

• Tuition reimbursement program.

• Parental leave benefits.