Quality Auditor

Job Summary

Working remotely on a full-time basis, the Quality Auditor will conduct audits of second-level appeals of claims to ensure compliance with contract requirements, perform data analysis, and provide training and feedback to staff.

Key responsibilities

• Perform audits and examinations of case files to identify inaccuracies and non-compliance issues
• Share educational feedback and insights with staff to enhance the appeals process
• Prepare training materials and provide technical training to employees

Required qualifications

• High School Diploma or equivalent
• Three (3) years of general office experience or equivalent education in administration, business, or related fields
• One (1) year of experience in Qualified Independent Contractor (QIC) appeals or other healthcare appeals processes
• Preferred experience with Medicare Part C related appeals activities
• Residency in the United States for a minimum of three (3) years out of the last five (5) years