QA Audit Specialist and Trainer

Integrated Home; Florida; On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical, Vision, Dental, Short- and •

6+ Days of Holidays Pay

13 days of PTO

Employer paid life insurance

401K with employer contribution

Wellness program with reward incent

Employee recognition and reward程序

Job summary

Integrated Home Care Services (IHCS) is seeking a QA Audit Specialist and Trainer to strengthen regulatory compliance across HH, DME, and infusion services. You will lead audits, train staff, and collaborate with cross-functional teams to ensure accuracy and adherence to CMS, NCQA, URAC standards.

Join IHCS to help drive continuous improvement, support quarterly audits, and promote high-quality patient care in a dynamic home health environment in Florida.

Qualifications

• 2-5 years of experience in healthcare auditing, quality assurance, or utilization management.
• Experience with state and federal regulations including Medicare/Medicaid.
• Familiarity with accreditation standards (URAC, NCQA, Joint Commission, ACHC).
• Strong understanding of utilization management and medical necessity criteria (CMS/NCQA/URAC).
• Proficient with Microsoft Word, Excel, and PowerPoint.

Responsibilities

• Ensure compliance with state and federal regulations for prior authorization across HH, DME, and infusion services.
• Support health plan audits conducted quarterly or annually.
• Conduct monthly employee audits to assess policy adherence and identify improvement areas.
• Provide actionable feedback to improve quality and regulatory compliance.
• Collaborate with internal teams to maintain accuracy and efficiency of prior authorization procedures.

Skills

Healthcare auditing

Regulatory compliance

Data analysis

Investigative skills

Problem-solving

Tools

Microsoft Office

Job description

Integrated Home Care Services (IHCS) provides a comprehensive Integrated Delivery System in the home setting, offering Durable Medical Equipment (DME), Respiratory, Home Health, and Home Infusion services. Through our select network of Medicare and Medicaid Certified and Accredited providers, we are available 24/7 to meet the needs of our patients with compassion, expertise, and excellence.

For more than 30 years, we have been dedicated to improving lives by delivering the highest quality in-home care services. As a trusted market leader in value-based Home Health, Durable Medical Equipment, and Home Infusion Services, we proudly serve more than 2 million lives across the United States and the Commonwealth of Puerto Rico. Our integrated care model is trusted by leading Managed Care Organizations (MCOs), physicians, and healthcare partners because of our commitment to exceptional patient outcomes and coordinated care.

At IHCS, our patients are at the heart of everything we do. We believe in creating a culture built on compassion, integrity, collaboration, and innovation. Every team member plays a vital role in fulfilling our mission of enhancing the quality of life for those we serve through Exceptional Customer Service, Proven Outcomes, and Seamless Care.

If you are passionate about making a meaningful impact, thrive in a collaborative environment, and are committed to excellence, we invite you to join our growing team. Together, we can continue transforming home healthcare while making a difference in the lives of our patients and the communities we serve.

Join IHCS where our patients are 1, and our people make the difference.

Offering a competitive compensation package, including but not limited to;

• Medical, Vision, Dental, Short- and Long-term insurance
• 6+ Days of Holidays Pay
• 13 days of PTO
• Employer paid life insurance
• 401K with employer contribution
• Wellness program with reward incentives
• Employee recognition and reward programs

What you will be doing:

The QA Audit Specialist and Trainer is responsible for ensuring compliance with state and federal regulations related to prior authorization processes for home health (HH), durable medical equipment (DME), and infusion services. This applies to internal processes, as well as, providing support during health plan audits performed quarterly and/or annually. This role involves conducting detailed employee audits on a monthly basis to assess adherence to established policies & procedures, guidelines, identifying areas for improvement, and providing feedback to enhance overall quality and regulatory compliance. The specialist collaborates with internal teams to maintain accuracy, efficiency, and consistency in prior authorization procedures while supporting continuous process.

Qualifications:

• 2-5 years of experience in healthcare auditing, quality assurance, compliance, or utilization management, preferably in prior authorization for Home Health (HH), Durable Medical Equipment (DME), and Infusion services
• Experience working with state and federal healthcare regulations, including Medicare, Medicaid, and commercial health plans.
• Familiarity with accreditation standards (URAC, NCQA, Joint Commission, ACHC) is a plus.
• Strong understanding of utilization management, medical necessity criteria, and regulatory compliance (e.g., CMS, NCQA, URAC).
• Proficient in Microsoft products (Word, Excel, Powerpoint)
• Strong problem-solving and investigative skills.

Join our team as we strive for excellence through teamwork, where our patients are 1!

IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Experience

Required

Ability to analyze and interpret complex data and regulatory guidelines

Familiarity with accreditation standards (URAC, NCQA, Joint Commission, ACHC).

Experience working with state and federal healthcare regulations, including Medicare, Medicaid, and commercial health plans.

2-5 years: Experience in healthcare auditing, quality assurance, compliance, or utilization management, preferably in prior authorization for Home Health (HH), Durable Medical Equipment (DME), and Infusion services

Equal Opportunity Employer
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