QA Auditor, Appeals and Grievances - Remote

Overview

The Quality Assurance Auditor is responsible for performing Internal Quality Assurance Audits of Operational processes to ensure compliance with policies, procedures, and quality standards.

In Short

• Conduct quality audits of Appeals and Grievances (A&G) items.
• Analyze errors and determine root causes.
• Track and trend findings to improve processes.
• Review and investigate appeals and grievances requests.
• Present investigation results to senior staff.
• Participate in regulatory and mock audit activities.
• Assist in developing departmental policies and procedures.
• Meet established performance time frames.
• Handle confidential information responsibly.
• Work under minimal supervision.

Requirements

• Experience with appeals and grievance processes.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint).
• High School Diploma or GED required.
• Associate degree preferred.
• ICD10 certification is a plus.
• Experience in an auditing capacity.
• Knowledge of state and federal regulatory requirements.
• Ability to handle confidential information.
• Strong analytical skills.
• Excellent communication skills.

Benefits

• Medical, dental, and vision coverage.
• Incentive and recognition programs.
• Life insurance.
• 401k contributions.
• Competitive compensation package.
• Opportunities for career growth.
• Supportive workplace culture.
• Focus on employee well-being.
• Commitment to community health.
• Equal opportunity employer.