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:

• Be responsible for performing audits that are routine in nature where limited judgment is required
• Focus on single area of expertise or line of business (Claims, Inquiry, Enrollment); objectively review and interpret standards, procedural documentation and contract and legal verbiage
• Identify and document audit observations and findings
• Notify Supervisor when communications with operations are necessary; coordinate appropriate messaging 
• Identify and resolve routine problems independently; escalate issues with Supervisor as appropriate
• 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 a high school diploma or GED
• Requires at least 5 years of prior relevant experience
• 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