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, communicate findings with initial auditors, and mentor junior staff while working independently in a healthcare environment.

Key responsibilities

• Conducts clinical quality assurance reviews and communicates discrepancies with initial auditors to ensure accuracy
• Applies healthcare auditing principles and objectivity in medical audit activities and reviews
• Mentors other QA auditors and may flex into initial audit or appeals roles as needed based on business requirements

Required qualifications

• Associates 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
• Current coding certification (RHIA, RHIT, CCS, or CIC) required; CCDS or CPC candidates must obtain inpatient coding certification within one year of hire
• 3-5 years of healthcare auditing or related experience
• Proficiency in Microsoft Office Suite (Excel, Outlook, PowerPoint, SharePoint)