As a Quality Assurance Operations Auditor in a remote capacity, you will be responsible for conducting internal audits of non-financial operational processes. Your role will ensure compliance with company policies, procedures, and quality standards for both internal employees and outsourced vendors.
Key Responsibilities
- Perform routine random and targeted audits across various operational processes such as call centers, enrollment/terminations, invoicing, member/provider notifications, and more.
- Confirm adherence to company, state, and federal policies, including compliance with regulatory guidelines.
- Investigate and conduct root cause analysis for identified issues, handling determinations, and tracking/trending findings.
- Prepare detailed audit reports and communicate findings to appropriate leadership.
- Identify areas for improvement in quality, operational efficiency, and production goals.
- Analyze audit data to identify patterns, trends, and variances, providing actionable feedback to departmental leaders.
- Meet established time frames and performance metrics for audit quality and quantity.
- Conduct compliance audits to ensure accuracy and timeliness in handling member and provider accounts.
Additional Responsibilities
- Provide recommendations to enhance controls, efficiency, and compliance measures.
- Assist in developing and refining departmental policies and procedures.
- Review and enhance accuracy of existing training materials.
- Maintain strict adherence to HIPAA guidelines and confidentiality of sensitive information.
Minimum Qualifications
- Experience in healthcare operations, preferably in Quality Assurance, contact centers, member enrollment, billing, or provider data management.
- Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook).
- Strong analytical skills with the ability to provide creative problem-solving ideas.
- Effective written and verbal communication skills.
- High School Diploma or GED.
Preferred Qualifications
- Experience handling Personal Health Information (PHI) with professionalism.
- Previous experience in auditing, including root cause analysis.
- Ability to manage increasing workload and responsibilities.
- Willingness to learn and evaluate new technical and procedural information.
- Knowledge of multiple lines of business such as Medicare, Medicaid, etc.
- Associate degree or higher.
Compliance & Regulatory Responsibilities: All responsibilities related to compliance and regulatory guidelines as applicable to the position.
Salary and Benefits:
- Salary range varies by location:
- Greater New York City Area: $47,403 - $62,400
- All Other Locations: $41,101 - $60,320
- Comprehensive benefits package including health, dental, vision insurance, life insurance, 401k contributions, and more.
- Remote work opportunities available.
- Equal opportunity employer committed to diversity and inclusion.
Application Process
Interested candidates should apply through the Healthfirst website, referencing Job ID healthfirst-R018326.
Perks and Benefits
- Health and wellness benefits including fitness subsidies, mental health benefits, and more.
- Parental benefits including maternity leave and family support resources.
- Work flexibility with remote and hybrid work options.
- Office perks like commuter benefits, casual dress, and company events.
- Paid vacation, holidays, and personal/sick days.
- Financial and retirement benefits including 401(k) with company matching and performance bonuses.
- Professional development opportunities such as tuition reimbursement and access to online courses.
- Diversity and inclusion initiatives including Employee Resource Groups and DEI programs.
Conclusion
At Healthfirst, we offer a competitive compensation package and a supportive work environment where your contributions are valued. We encourage diversity and provide opportunities for professional growth and development.
Find out more and apply today to join our team dedicated to quality and compliance in healthcare operations.
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