Remote Provider Network QA Specialist

Alliance Health; Morrisville (NC); Remote; USD 70,000 - 89,000; Full time

Benefits offered by this job

Medical, Dental, Vision, Life, Long‑to

Hybrid/Remote options

Retirement savings plan

PTO incl. vacation, sick, holiday

Dress flexibility

Job summary

Alliance Health is seeking a Provider Network Quality Assurance Specialist to monitor, audit, and improve the quality and compliance of provider network operations. This remote role requires North Carolina residence with possible onsite meetings in Morrisville.

The position emphasizes audit scheduling, data analysis, and maintaining robust documentation to support regulatory reviews and process improvements.

Qualifications

• Bachelor’s degree in related field with at least five years of QA/improvement experience.
• Excel proficiency to analyze data and produce graphs and tables.

Responsibilities

• Conduct Quality Audits of Provider Network Operations Processes.
• Develop and maintain an audit schedule; analyze data and make recommendations.
• Maintain audit evidence and records for review readiness.
• Review Provider Records, Contracts, and Enrollment Documentation for accuracy; document trends.
• Validate compliance with DHB, NCQA, State, and organizational requirements; document gaps and risks.
• Perform root cause analysis and track corrective actions with accountable teams.

Skills

Quality Assurance

Data Analysis

Auditing

Excel

Project Management

Communication

Education

Bachelor’s Degree in Sociology

Bachelor’s Degree in Psychology

Bachelor’s Degree in Public Health

Bachelor’s Degree in Statistics

Bachelor’s Degree in Economics

Bachelor’s Degree in Business Administration

Tools

Salesforce

Alliance Claims System (ACS)

Job description

Alliance Health is seeking a Provider Network Quality Assurance Specialist to monitor, audit, and improve the quality and compliance of provider network operations. This remote role requires North Carolina residence with possible onsite meetings in Morrisville.

The position emphasizes audit scheduling, data analysis, and maintaining robust documentation to support regulatory reviews and process improvements.