Quality Control Auditor

Ram Technologies

3d•$45,000 - $50,000•Remote

About The Position

The Quality Control Auditor will complete standard functional pre and post transaction outcome reviews to determine the accuracy and compliance of each transaction. This role will be responsible for staying current on expected operational outcomes and aligning each quality review against the appropriate process, contractual service-level agreements, and compliance guidelines in place at the time of processing. The candidate must ensure clearly documented details regarding the outcome of each audit and must work with operational delivery to provide feedback aimed at identifying root cause and corrective action steps. The specialist must have excellent problem-solving skills, along with keen attention to detail and outstanding written and oral communication abilities.

Requirements

Experience in performing and documenting quality reviews of healthcare transactions.
Attention to detail and the ability to work under time constraints.
MS PowerPoint, MS Word, MS Excel, MS Access.
Exceptional interpersonal, listening, written and oral communication abilities.

Nice To Haves

Experience in BPaas environment is a plus.
Experience in review of system configuration is a plus.

Responsibilities

Perform quality reviews of random and/or targeted periodic audits
Document outcomes of each quality audit
Aid in identification of compliance risks, root cause analysis, and corrective action steps to address findings
Collaborate with operations to drive continuous quality improvement initiatives
Audits for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures.
Select audits through random processes and/or other criteria.
Makes recommendations to improve quality, workflow processes, policies, and procedures.