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 grievances and appeals.
• Analyze errors and determine root causes.
• Record and track quality assessment scores.
• Present results of investigations to senior staff.
• Identify defects to improve departmental performance.
• Assist in developing departmental policies and procedures.
• Participate in regulatory and mock audit activities.
• Handle processing of appeal and grievance requests.
• Work under minimal supervision.
• Meet established performance rates.

Requirements

• Experience with appeal and grievance processes.
• Proficiency in Microsoft Office Suite.
• High School Diploma or GED required.
• Associate degree preferred.
• ICD10 certification is a plus.
• Experience in an auditing capacity.
• Knowledge of state and federal regulations.
• Experience handling confidential information.

Benefits

• Medical, dental, and vision coverage.
• Incentive and recognition programs.
• Life insurance.
• 401k contributions.
• Competitive compensation package.