Quality Assurance Auditor

Job Summary

Monitoring compliance with state and federal regulations, the full-time remote Quality Assurance Auditor will conduct pre-closure audits for Medicare and Medicaid appeals, track department performance, and support staff training and process improvement.

Key responsibilities

• Complete pre-closure audits of appeal and grievance cases to ensure accuracy and completeness
• Communicate with staff and departments to ensure thorough reviews of grievances, complaints, and appeals
• Monitor data entry for appeals and grievances, performing quality checks on reporting

Required qualifications

• High School diploma or equivalent
• 2+ years of experience as an Appeal Coordinator or in a related role
• Advanced knowledge of CMS Medicare and Medicaid rules and benefit plans
• Proficiency with Microsoft applications such as Word and Excel
• Ability to maintain confidentiality and project a professional business image