Quality Assurance Auditor, Specialist

Your Role

The Quality Review team completes audits of front-line staff to ensure alignment with department processes and regulatory compliance. Quality Assurance Auditors also provide coaching and work closely with business leaders to drive optimal results. The Quality Assurance Auditor, Specialist will report to the Quality Review Senior Manager. In this role you will develop performance metrics audit tools, evaluate performance, and provide coaching to ensure that staff have the skills and knowledge required to be successful in Population Health Management.

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
• Contributes to meeting and improving compliance performance
• Review audit data to identify care gaps, compliance risks, and trends
• Provide developmental coaching and support to all staff to improve the skills and competencies required to successfully perform work

Your Knowledge and Experience

• Requires a high school diploma or GED
• Requires at least 7 years of prior relevant experience
• Attention to details and the ability to communicate effectively 
• Auditing experience preferred
• Knowledge of Health Plan operations, lines of business, general healthcare industry standards
• Strong organizational skills to conduct audits and reporting timely
• Hands-on experience using MS Office applications including Excel, Word, Outlook, PowerPoint preferred