Remote IDRE Quality Assurance Specialist

North Haven Solutions; Oregon; Híbrido; USD 70.000 - 95.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision coverage

Voluntary life insurance options

Hospital indemnity, critical illness,

Disability coverage for short-term and

401k with company match

Remote workspace Apple equipment & a媒体

Descripción de la vacante

North Haven Government Services Solutions is seeking an IDRE QA Specialist to join our Operations team. This role supports Independent Dispute Resolution processes, ensuring accuracy, completeness, and timely delivery of reviewer reports to CMS.

The QA Specialist coordinates with customers, reviewers, and management to meet established requirements and deadlines. The ideal candidate is highly organized, detail-oriented, with strong communication, problem-solving, and HIPAA/PHI handling

Formación

• The ideal candidate is highly organized and detail-oriented.
• Strong communication, sound judgment and problem-solving abilities.
• Commitment to accuracy and HIPAA/PHI handling awareness.

Responsabilidades

• Review reviewer reports for accuracy, completeness, and adherence to requirements.
• Coordinate with customers, reviewers, and management to resolve questions and address deficiencies.
• Ensure reports meet quality standards and CMS deadlines.
• Identify discrepancies and opportunities for improvement in the review process.
• Maintain understanding of IDRE requirements and company processes.
• Contribute to continuous process improvement to enhance quality and turnaround times.
• Collaborate with Operations to support growth and success.
• Evaluate dispute rationale to ensure compliance with guidelines.
• Follow up with arbiters for missing information and ensure secure communications.

Educación

LPN, Associate’s or Bachelor’s degree preferred

Relevant professional experience may substitute for degree

Descripción del empleo

North Haven Government Services Solutions is seeking an IDRE QA Specialist to join our Operations team. This role supports Independent Dispute Resolution processes, ensuring accuracy, completeness, and timely delivery of reviewer reports to CMS.

The QA Specialist coordinates with customers, reviewers, and management to meet established requirements and deadlines. The ideal candidate is highly organized, detail-oriented, with strong communication, problem-solving, and HIPAA/PHI handling