Quality Assurance Auditor – Regulatory Compliance

Independent Health; Elizabeth (NJ); On-site; USD 33,062 - 37,195; Full time

Job summary

Independent Health in New Jersey seeks a Quality Assurance Auditor to monitor, audit, and assure compliance across all lines of business in line with CMS, NYS DOH, NYS DFS and internal policies. You will track issues, report results to stakeholders, and collaborate with QA and cross-functional teams to remediate findings and improve testing strategies.

Occasional evenings, weekends, and holidays may be required, with a focus on maintaining high standards of accuracy and regulatory compliance in

Qualifications

• High school diploma or GED required; Associate’s degree preferred.
• Three (3) years of quality assurance/quality control, compliance monitoring, pharmaceutical or managed care environment.
• Experience with Medicare, Medicaid or another government program strongly preferred.
• Experience with pharmacy on-line claims processing systems preferred.
• Strong analytical, problem solving, time management and organizational skills.
• Ability to use independent judgment and solid reasoning skills when rendering decisions and troubleshooting issues.

Responsibilities

• Develop, implement, and maintain manual and automated test scripts utilizing testing tools.
• Develop, implement, and maintain test cases, data, files and strategies.
• Participate in all aspects of testing including functional, regression, performance and system testing.
• Log and manage defect status and resolution within the QA software tool.
• Develop, implement, and maintain policies, procedures, manuals, and other necessary documentation of the QA/QC process.
• Conduct internal audits to measure and ensure adherence to claims processing standards, technical requirements, supporting processes, systems, and required program documentation.
• Support cross-functional projects, represent the QA team at meetings, review requirements, develop test approach, and provide feedback.
• Work on issues of moderate to complex scope where analysis of data is required.
• Develop effective relationships that support appropriate feedback and development.
• Report QA and audit results to management and leadership teams.
• Identify, monitor and communicate trends in inaccuracies and work with PBD teams to resolve them, ensuring compliance with standards, policies, procedures, and government regulations.
• Perform ad hoc queries in audit database in support of decision making.
• Perform integration testing and track, document, and verify resolution while working with subject matter experts to resolve defects.
• Maintain knowledge of all line of business requirements and operational processes and develop plans to improve quality standards.
• Work with associates to predict, identify, resolve and document problems, clarify issues quickly and ensure successful resolution with minimal supervision.
• Develop and maintain interdepartmental relationships throughout the company.

Skills

QA experience

Analytical skills

Communication skills

Time management

Problem solving

Independent judgment

Detail oriented

Education

High school diploma

Associate degree preferred

Tools

AS400

Query tools

Testing tools

Job description

Independent Health in New Jersey seeks a Quality Assurance Auditor to monitor, audit, and assure compliance across all lines of business in line with CMS, NYS DOH, NYS DFS and internal policies. You will track issues, report results to stakeholders, and collaborate with QA and cross-functional teams to remediate findings and improve testing strategies.

Occasional evenings, weekends, and holidays may be required, with a focus on maintaining high standards of accuracy and regulatory compliance in