Quality Auditor - Provider Relations

Job Description

We are searching for a Quality Auditor-- someone who works well in a fast-paced setting. In this position, you will be responsible for reviewing and evaluating the quality and effectiveness of the department policies and procedures, processes, and system updates such as member eligibility, provider setup, benefit/contract/edit configuration, and/or code/rate updates. This role will partner with the department managers on audit findings to ensure identified errors are promptly and appropriately corrected, as well as identified performance and/or training gaps are addressed. The Quality Audit also tracks and reports quality metrics for the department and serves as the department's point of contact for audit inquiries.

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Job Duties & Responsibilities