Quality Auditor Jobs

About The Position

Requirements

• Associate's degree in Healthcare Administration or a technical diploma in a healthcare-related field.
• Strong analytical, auditing, and organizational skills.
• Ability to communicate effectively with providers, leadership, and cross-functional teams.
• Understanding of medical record documentation and coding guidelines.
• Knowledge of medical insurance claims processes.
• Familiarity with insurance contracts.

Nice To Haves

• Two or more years of healthcare-related work experience.
• Clinical experience as a medical assistant (MA) or licensed practical nurse (LPN).
• Experience with electronic medical records, EPIC, and Microsoft Office.
• Familiarity with quality measures such as HEDIS.

Responsibilities

• Review medical records, extract data for quality and audit metrics, and verify documentation and coding accuracy.
• Review insurance payer reports and data, and conduct audits and medical record validation.
• Assist with implementing new contracts and programs, ensuring workflows and processes meet quality metric requirements.
• Develop educational materials and provide guidance to providers and staff on quality metrics, documentation standards, and contract requirements.
• Analyze quality-related terms in assigned insurance contracts and amendments, and communicate measure requirements and performance thresholds.
• Prepare audit reports and streamline workflows to meet monthly, quarterly, and annual quality and performance goals.
• Monitor assigned contract performance, identify gaps in quality requirements, and recommend and support corrective actions.
• Identify and support opportunities to automate quality data extraction using EPIC or other data sources.
• Collaborate with the Clinical Optimization Team, Chief Quality Officer, Chief Financial Officer, and physicians and clinicians to develop and implement best practices for quality-related workflows.

Benefits

• Continuous education, training, and support.