Job Title: Quality Auditor
Location: 100% Remote
Job Duration: 4 months contract (Possible extension)
Schedule: M-F, 8am – 5pm PST (Regular Business Hours)
Pay Range: $35 to $40/hr. on W2
Job Summary:

• This position is responsible for conducting quality audits related to state audits, HEDIS, quality referrals, and complaints.
• The role also supports the preparation of weekly, monthly, quarterly, and year-end reports and assists the Quality Management department with quality improvement initiatives.

Important Details:

• Candidates can be located in any of the five states: NJ, NY, PA, CT, and DE.
• Expected Oct month start date (Pre HEDIS project).
• You will be required to travel for the pickup and return of equipment, and/or laptops that need servicing.

Responsibilities:

• Conduct on-site and virtual reviews at participating provider offices to assess the environment, quality of physician medical records, and compliance with documentation standards.
• Prepare documentation summarizing on-site findings, communicate results to physicians, provide education, and identify opportunities for improvement.
• Provide data support to facilitate quality processes and analyze trends and patterns related to quality improvement and health management.
• Assist the Quality Management department with special projects and focused clinical studies.
• Perform other related tasks and special studies as requested.
• Assist with training internal Client NJ Health staff, providers, and vendors on programs and audit standards, both on-site and off-site.
• Serve as the in-house representative and project lead for state audits.
• Analyze audit findings and identify trends, deficiencies, and opportunities for improvement.
• Prepare and produce various reports as requested.
• Coordinate and manage the Corrective Action Plan (CAP) process for assigned audit types.
• Conduct re-audits to ensure that previously identified deficiencies have been appropriately addressed.

Qualifications:
Education and Experience:

• Requires three to five years of related business experience, preferably within the healthcare industry.
• Requires a Licensed Practical Nurse (LPN) license or an active New Jersey Registered Nurse (RN) license.
• Additional Licensing, Certifications, and Registrations
• Requires a valid motor vehicle driver’s license and access to an automobile.

Knowledge:

• Knowledge of managed care principles.
• Knowledge of medical terminology.
• Proficiency with PCs and related software applications.
• Knowledge of URAC accreditation standards and HEDIS principles preferred.
• Knowledge of health management or patient education preferred.

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