Quality Audit Specialist

University Health; San Antonio (TX); On-site; USD 60,000 - 90,000; Full time

Job summary

Community First Health Plans, Inc. is seeking a Quality Audit Specialist to conduct independent audits across regulatory, contractual, accreditation and organizational requirements.

The role evaluates documentation accuracy, process adherence, and operational effectiveness, identifies risks, and supports readiness efforts while maintaining objectivity.

Collaborating with interdisciplinary leadership, you will help develop improvements that elevate compliance and overall performance.

Qualifications

• 3-5 years of healthcare-related experience is required.
• Experience in audits, utilization review, or quality assurance is preferred.
• Strong written and verbal communication skills.
• Proficient in Microsoft Office (Word, Excel, PowerPoint).
• Excellent organizational and time management skills; ability to prioritize tasks.
• Knowledge of Medicare, Medicaid, HMO, and private insurance coverage is highly preferred.

Responsibilities

• Conduct independent audits to evaluate compliance with regulatory, contractual, accreditation, and organizational requirements.
• Assess documentation accuracy, process adherence, and operational effectiveness.
• Identify areas of risk and opportunities for improvement; support readiness efforts.
• Track and analyze audit results; monitor trends.
• Collaborate with interdisciplinary leadership to develop and implement process improvements.

Skills

Auditing

Regulatory knowledge

Written communication

Verbal communication

Education

Healthcare-related coursework preferred

Job description

POSITION SUMMARY/RESPONSIBILITIES

The Quality Audit Specialist is responsible for conducting independent audits and reviews to evaluate compliance with regulatory, contractual, accreditation, and organizational requirements across Community First Health Plans, Inc. (Community First). This role assesses documentation accuracy, process adherence, and operational effectiveness, identifies areas of risk and improvement, and supports organizational readiness efforts. The Quality Audit Specialist tracks and analyzes audit results, monitors trends, and collaborates with interdisciplinary leadership to develop and implement process improvements that enhance compliance, quality outcomes, and overall organizational performance while maintaining an objective and unbiased approach to all audit activities.

EDUCATION/EXPERIENCE

3-5 years of healthcare-related experience is required. College level course work preferred. Work experience in audits, utilization review, or quality assurance is preferred. Strong written and verbal communication skills. Proficient in using computer applications, including Microsoft Office (Word, Excel, PowerPoint). Excellent organizational and time management skills, with the ability to prioritize tasks effectively. Detail-oriented and able to maintain a high level of accuracy in work products. Knowledge of the criteria for Medicare, Medicaid, HMO, and private insurance coverage is highly preferred.

LICENSURE/CERTIFICATION

Certification in a health-related field preferred but not required.