Quality and Compliance Specialist

SKYGEN; Menomonee Falls (WI); Remote; USD 54,000 - 83,000; Full time

Job summary

An established industry player is seeking a dedicated Quality Improvement Specialist to enhance service quality across departments. This fully remote role involves conducting client audits, analyzing processes, and collaborating with teams to resolve quality-related concerns. The ideal candidate will possess strong communication skills and a background in healthcare or managed care. Join a forward-thinking company that values improvement and consistency, offering a competitive salary and opportunities for professional growth.

Qualifications

• 1+ years of quality related experience in healthcare or managed care.
• Familiarity with QA methodologies and insurance claim processing.

Responsibilities

• Conduct client audits and collaborate with departments on quality concerns.
• Monitor processes to identify trends and report metrics to management.

Skills

Excellent oral and written communication skills

Ability to manage competing tasks

Microsoft Office Suite

Education

Bachelor's Degree in a related field

Job description

Important things YOU should know:

• Fully Remote Role

• Schedule: Monday - Friday 8am to 4:30pm CST or 8:30am - 5:00pm CST

What will YOU be doing for us?

Responsible for working with all company departments to secure the highest quality of services and output for each of the company's necessary processes and activities. Under the direction of the Quality Improvement Manager, this position will work to provide consistency in the company's actions and services, while seeking improvement areas for such actions and services.

What will YOU be working on every day?

• Conduct client audits - triage requests and work with Subject Matter Experts (SME) to obtain necessary documentation to fulfill client request.

• Process Internal Priority Quality Improvement Projects (IPQI) with internal SME. Coordinate meetings, drive team toward problem resolution.

• Monitor company processes through analysis and observation to identify trends, best practices, and achievement of goals and deliverables.

• Report all quality driven analysis, metrics, and trends to Director and make recommendations as appropriate.

• Collaborate with other departments and staff to address all quality related concerns.

• Work with Clients to address and resolve all quality related concerns.

• Aid in the development of workflows and processes.

• Maintain current knowledge of policies, procedures and processes.

• Responsible for the development and coordination of meeting agendas and meeting minutes for compliance and quality related meetings.

• Assist Compliance with Client issued corrective actions such as tracking and follow up with deliverables, as needed.

What qualifications do YOU need to have to be GOOD candidate?

• Required Level of Education, Licenses, and/or Certificates

  • Bachelor's Degree in a related field or equivalent years of job related experience.

• Required Level of Experience

  • 1+ years of previous quality related or related business experience such as claims, credentialing or reimbursement.

  • Prior experience in the healthcare or managed care industry such as a hospital, dental office or insurance company.

• Required Knowledge, Skills, and Abilities

  • Excellent oral and written communication skills.

  • Ability to manage several competing tasks at once effectively while still meeting deadlines.

  • Demonstrated experience with Microsoft Office Suite

What qualifications do YOU need to have to be GREAT candidate?

• Preferred Level of Education, License, and/or Certificates

  • Six Sigma

• Preferred Level of Experience

  • Prior experience in managed care, POS, PPO, self-insured groups, and Medicaid/Medicare.

• Preferred Knowledge, Skills, and Abilities

  • Familiarity with QA methodologies

  • Knowledge of Enterprise System and/or an insurance claim processing system

  • Knowledge of process management

  • Knowledge of Company Structure

  • Ability to be self-directed, including ability to prioritize & reprioritize quickly

  • Ability to be proactive, foresee need for assistance and take initiative to engage others

  • Ability to be tactful, diplomatic, and compliant

  • Ability to be organized

The salary range and midpoint is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.

Compensation Range:

$54,705.00 - $82,058.00

Compensation Midpoint:

$68,381.00