State Licensed Quality Auditor

Job Summary

To ensure compliance with quality standards for recoverable claims, the full-time State Licensed Quality Auditor will perform clinical quality assurance reviews, mentor other auditors, and communicate findings while working independently in a healthcare auditing environment.

Key responsibilities

• Conduct clinical quality assurance reviews and communicate discrepancies with initial auditors to ensure accuracy
• Apply healthcare auditing principles and objectivity in medical audit activities
• Review medical records to assess medical necessity and identify potential billing or coding issues

Required qualifications

• Associate's or Bachelor's degree in Nursing with an active/unrestricted license
• 5+ years of experience in claims auditing, quality assurance, or recovery auditing, preferably in a Clinical Validation Audit setting
• Relevant coding certification (RHIA, RHIT, CCS, or CIC) required; CCDS or CPC candidates must obtain inpatient coding certification within 1 year
• 3-5 years of healthcare auditing or related experience
• Proficiency in Microsoft Office Suite (Excel, Outlook, PowerPoint, SharePoint)