Quality Assurance Specialist

Job Summary

A company is looking for a Quality Assurance Specialist-Appeal & Grievance to ensure data accuracy and regulatory compliance in a remote setting.

Key Responsibilities

• Monitor and review Appeals and Grievances data to meet Star Measure goals
• Analyze and validate the accuracy of data in compliance with CMS requirements
• Assist in training, audits, and quality improvement initiatives related to appeals and grievances

Required Qualifications

• 2+ years of healthcare appeals & grievances experience or related QA experience
• 2+ years of managed healthcare experience
• High School Diploma or GED with relevant work experience; Bachelor's degree preferred
• Knowledge of Appeals and Grievance procedures and CMS regulatory compliance guidelines
• Demonstrated knowledge of CMS Reporting and Medicare Managed Care Plans