Senior Quality Auditor

Job Summary

The primary purpose of this position is to identify, analyze and improve quality, to ensure delivery of SLA quality metrics per client contract. This includes but is not limited to auditing, creating & reviewing quality reports, trending and analyzing audit findings, answering questions, client communications, training, staff management, continuing education programs assisting in the development of employees so they can keep pace with the changing needs of the organization, and to ensure that processes are in place to meet the goals and objectives of the client and the organization. 

Key Accountabilities/Responsibilities:

• Work with minimal supervision using professional skills, discretion and sensitivity while addressing various quality and training expectations
• Work as a team member in determining departmental needs
• Serve as a resource for employees and management
• Staff management and performance management
• Provide quality review and training for the further development of each employee
• Communicates deadlines and goals to team members
• Work well with a variety of individuals and resolve issues professionally
• Be a leader who interfaces with various operations management personnel
• Provide timely quality follow-through in the form of audits and development sessions
• Conducts team meetings to update members on best practices and continuing expectations
• Provides quality client handling, including interacting with clients, answering queries, and effectively handling customer complaints
• Performs other work-related duties as assigned.

Qualifications Required:

• Domain/Industry experience with at least 1 to 2 years of experience in claims processing
• Thorough knowledge of medical terminology, claim processing procedures/systems, auditing, and a thorough understanding of claim protocols and industry standards and CMS regulations as it relates to claims payment and compliance.
• Knowledge and work experience with ICD9, ICD10, CPT and different coding systems (preferable)
• Good Communication Skills – Both Verbal and Written [preferred]
• Eye for Details.
• Logical thinking and Analytical Skills.
• Knowledge of basic quality tools
• Proficiency in MS Office (PowerPoint, Excel & Word)
• Ability to multi-task and manage time efficiently under the pressure of deadlines.
• Problem solving & result oriented skills

We are an Equal Opportunity Employer.  All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state, or local law.

It is the policy of this Company to seek and employ qualified individuals at all locations and facilities, and to provide equal employment opportunities for all applicants and employees in recruiting, hiring, placement, training, compensation, insurance, benefits, promotion, transfer, and termination. To achieve this, we are dedicated to taking affirmative action to employ and advance in employment qualified individuals with disabilities, disabled veterans, and other eligible veterans.