Remote QA Specialist – Claims & Compliance

GEHA Health; United States; Hybrid; USD 48,000 - 67,000; Full time

Benefits offered by this job

Health/Dental/Vision benefits

401(k) company match

Paid Time Off

Well-being program

Tuition Assistance

Life and AD&D insurance

Short-Term & Long-Term Disability

Job summary

GEHA Health is seeking a Quality Assurance Specialist to audit claims coding, provider interactions, and electronic files for accuracy and compliance. The role involves credentialing and provider relations audits, plus cross-functional collaboration to improve workflows and training materials.

The position requires an associate's degree or equivalent experience, plus 4 years in a related role, with strong communication and MS Excel/Word proficiency. Hybrid/work-from-home options are available.

Qualifications

• Requires an associate's degree (or equivalent experience).
• Requires effective written and verbal communication skills.
• Proficiency with MS Word and MS Excel.
• Thorough knowledge of Provider Data Management policy and procedures.

Responsibilities

• Updates and completes daily, monthly, and annual reports.
• Prepares responses to correspondence and manages complex provider issues and calls.
• Answers questions from PDM staff and other departments regarding provider updates and issues.
• Makes recommendations to improve quality, workflow processes, policies, and procedures.
• Credentialing: Audits and verifications as listed (SAL Audit, WAP Audit, OGM Invalid License, IH Initial & Re-Creds, Cred Verification, MS Review Audit, Contract Audit).
• Provider Relations: Call Audits, Service Issue Audit, Case Audit, Audit Errors; assist with department training.

Education

Associate degree

Tools

MS Word

MS Excel

Job description

GEHA Health is seeking a Quality Assurance Specialist to audit claims coding, provider interactions, and electronic files for accuracy and compliance. The role involves credentialing and provider relations audits, plus cross-functional collaboration to improve workflows and training materials.

The position requires an associate's degree or equivalent experience, plus 4 years in a related role, with strong communication and MS Excel/Word proficiency. Hybrid/work-from-home options are available.