QA Auditor, Appeals and Grievances - Remote

Employer Industry: Healthcare Services

• Salary up to $80,070 for Greater New York City Area residents
• Comprehensive benefits package including medical, dental, and vision coverage
• Incentive and recognition programs to reward outstanding performance
• Opportunity for career advancement and growth within the organization
• Supportive work environment that promotes operational efficiency and quality
• Chance to make a positive impact on compliance and quality assurance processes

• Conduct quality audits of grievances and appeals, analyzing errors and determining root causes
• Record and track quality assessment scores, providing feedback aimed at reducing errors
• Review and investigate appeals and grievances to ensure compliant resolutions
• Present investigation results to senior staff and prepare detailed reports
• Participate in regulatory audits and assist in developing departmental policies and procedures

• Experience with investigation, resolution, and reporting of appeal and grievance processes
• Proficiency in Microsoft Office applications including Excel, Word, and Power Point
• High School Diploma or GED from an accredited institution
• Ability to meet established performance time frames and quality standards
• Experience handling confidential information

• Associate degree from an accredited institution
• ICD
  10 certification
• Experience in an auditing capacity conducting root cause analysis
• Knowledge of multiple lines of business such as Medicare and Medicaid
• Familiarity with state and federal appeal and grievance regulatory requirements

#Healthcare Services #Quality Assurance #Career Opportunity #Competitive Pay #Regulatory Compliance

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