Clinical QA Ops Auditor - Bilingual English/Spanish - Remote

Healthfirst; Tennessee; Remote; USD 41,000 - 61,000; Full time

Job summary

Join a forward-thinking company as a Clinical QA Ops Auditor, where you will play a crucial role in ensuring compliance and quality standards within healthcare operations. This remote position involves performing audits, conducting root cause analyses, and providing actionable insights to improve operational efficiency. You will collaborate with various teams to uphold regulatory guidelines and enhance training materials. If you are detail-oriented and passionate about quality assurance in healthcare, this opportunity offers a dynamic work environment and a chance to make a significant impact in the industry.

Benefits

Medical coverage

Dental coverage

Vision coverage

Life insurance

401k contributions

Incentive and recognition programs

Qualifications

• Experience in Quality Assurance, contact center, or member enrollment.
• Proficient in Microsoft Office, especially Excel for data management.

Responsibilities

• Conduct internal audits of operational processes for compliance.
• Prepare audit reports and communicate findings to leadership.

Skills

Healthcare operations experience

Microsoft Office Suite (Excel, Word, PowerPoint, Outlook)

Analytical skills

Written and verbal communication

Education

High School Diploma or GED

Associate degree or higher

Job description

Clinical QA Ops Auditor - Bilingual English/Spanish - Remote

Join to apply for the Clinical QA Ops Auditor - Bilingual English/Spanish - Remote role at Healthfirst

Clinical QA Ops Auditor - Bilingual English/Spanish - Remote

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Join to apply for the Clinical QA Ops Auditor - Bilingual English/Spanish - Remote role at Healthfirst

The Clinical Quality Assurance Operations Auditor is responsible for performing Internal Quality Assurance Audits of non-financial Operational processes for internal employees, assisting with interpreting Clinical Care Manager call handling, and outsourced vendors to ensure compliance with policies, procedures, and quality standards. The incumbent investigates, audits, conducts root cause analysis, handles processing of determinations, and tracks/trends findings under minimal supervision.

• Perform routine random/target audits of operational processes (e.g., call centers, enrollment/terminations, invoicing/dunning, member/provider notifications, workforce management, sales/retention, etc.) across multiple lines of business and products
• Confirm employee adherence to company, state and federal policies and procedures including compliance and regulatory guidelines
• Prepare written audit reports on findings and communicates audit findings with appropriate leadership
• Identify quality, operational efficiency, and production goal defects to support the improvement of departmental performance
• Identify patterns, trends and variances related to audited performance and provide feedback to appropriate leaders
• Meet established time frames and rates of performance for both quality and quantity of work
• Conduct compliance audits to ensure member’s and/or provider accounts are accurately and timely handled according to contracted and regulatory guidelines
• Provide suggestions and recommendations on improving controls to gain efficiency and strengthening of performance and compliance measures
• Assist in the development of departmental policies and procedures
• Review the accuracy and efficiency of existing training materials
• Comply with HIPAA guidelines and maintain confidentiality of employee, member, provider, medical and departmental information
• Additional duties as assigned
  
  

MinimumQualifications

• Healthcare operations experience working in a Quality Assurance, contact center, member enrollment and billing, or provider data management
• Prior working experience with Microsoft Office suite of applications including Excel (which includes formatting formulas, managing data, and filtering results), Word, PowerPoint, and Outlook
• Experience conducting analytical work and providing creative ideas for problem solving
• Work experience requiring written and verbal communication that is clear, concise, grammatically correct, and professional
• High School Diploma or GED from an accredited institution
  
  

Preferred Qualifications

• Experience handling Personal Health Information (PHI) in a professional manner
• Experience in an Auditing capacity where you have conducted root cause analysis
• Ability and willingness to handle increasing workload and responsibility
• Willingness and ability to learn and evaluate new information, both technical and procedural
• Knowledge of at least two or more lines of business such as NY Medicare, Medicaid, Family Health Plus, or Child Health Plus, etc.
• Associate degree or higher
  
  

Compliance & Regulatory Responsibilities: See Above

License/Certification: N/A



Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400
• All Other Locations (within approved locations): $41,101 - $60,320
  
  

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

• The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance

• Industries

  Hospitals and Health Care

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