Quality Assurance Auditor, Advanced

Your Role

The Quality Review team completes audits of front-line staff to ensure alignment with department processes and regulatory compliance. Quality Assurance Auditors also provide coaching and work closely with business leaders to drive optimal results. The Quality Assurance Auditor, Experienced will report to the Quality Review Senior Manager. In this role you will develop performance metrics audit tools, evaluate performance, and provide coaching to ensure that staff have the skills and knowledge required to be successful in Behavioral Health Management Healthcare administration.

Your Work

In This Role, You Will:

• Perform audits and identify level of accuracy and competency with defined production and quality metrics
• Objectively review and interpret standard and procedural documentation
• Notify Senior Manager when communications with operations are necessary; assist with coordinating appropriate messaging
• Identify and resolve routine problems with minimal guidance, escalates issues with as appropriate
• Contributes to meeting and improving compliance performance
• Review audit data to identify care gaps, compliance risks, and trends
• Provide developmental coaching and support to all staff to improve the skills and competencies required to successfully perform work

Your Knowledge and Experience

• Requires minimum of 3 years of experience. May require vocational or technical education in addition to prior work experience
• Requires basic job knowledge of systems and procedures obtained through prior work experience or education
• Behavioral Health Management knowledge required, with understanding of behavioral health facility-based levels of care preferred

• Auditing Experience Preferred

• Knowledge of Health Plan operations, lines of business, general healthcare industry standards, and terminology preferred
• Strong organizational skills to conduct audits and reporting timely
• Attention to details and the ability to communicate effectively