State Licensed Quality Auditor

Job Summary

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

Key responsibilities

• Conduct clinical quality assurance reviews and resolve differing audit decisions with initial auditors
• Apply healthcare auditing principles to assess medical necessity and identify potential billing/coding issues
• Mentor junior auditors and flex into initial audit or appeals roles as business needs require

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