Remote Quality Assurance Specialist – Claims & Compliance

GEHA Health; Oregon; Hybrid; USD 48,000 - 60,000; Full time

Benefits offered by this job

Competitive pay/salary ranges

Incentive plan

Health/Vision/Dental benefits

401(k) retirement plan with company匹配

Robust employee well-being program

Paid Time Off

Personal Community Enrichment Time

Company-provided Basic Life and AD&D

Company-provided Short-Term & LongTerm

Tuition Assistance Program

Job summary

G.E.H.A is a nonprofit member association that provides health and dental benefits to federal employees and retirees.

The Quality Assurance Specialist audits claims coding, provider interactions, and compliance with policies and procedures, and participates in cross‑functional projects. This remote opportunity offers competitive pay, benefits starting day one, and a clear growth path within the organization.

Qualifications

• Requires an associate's degree. Will consider additional experience in lieu of degree.
• Requires 4 years of related experience.
• Requires effective written and verbal communication skills to answer questions from staff and providers.
• Requires proficiency with MS Word and MS Excel.
• Must have 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: Chairperson SAL Audit VP Files (CVO Initial & CVO Re-Creds) WAP Audit OGM Invalid License IH Initial & Re-Creds Cred Verification MS Review Audit Contract Audit.
• Provider Verification: Provider Relations: Call Audits Service Issue Audit Case Audit Audit Errors.
• Assists with department training. Contributes independently and collaboratively across departments and cross-functional projects. Analyzes audit reports and rebuttals to identify trends and recommend determination of outcome. Reviews and makes suggestions for changes/updates to training materials and existing desk-level procedures and policies.

Skills

Effective written and verbal comm.

MS Word

MS Excel

Education

Associate's degree

Job description

G.E.H.A is a nonprofit member association that provides health and dental benefits to federal employees and retirees.

The Quality Assurance Specialist audits claims coding, provider interactions, and compliance with policies and procedures, and participates in cross‑functional projects. This remote opportunity offers competitive pay, benefits starting day one, and a clear growth path within the organization.