Senior Auditor Quality - OPSP

Responsibilities

• Performs clinical quality assurance review of daily clinical validation reviews.
• Communicates with the initial auditor when there are differing decisions on the audit to ensure the final decision is supported and as accurate as possible.
• Integrates healthcare auditing principles and uses objectivity in performance of medical audit activities and review.
• Utilizes industry knowledge and proficiency in healthcare to substantiate decisions.
• Performs work independently and reviews work of others.
• Depending on the nature and scope of the audit, may review medical records and apply in-depth knowledge of clinical criteria to determine medical necessity, appropriateness of setting, potential billing/coding issues, and quality concerns.
• May serve as a mentor to other QA auditors or initial auditors.
• Depending on business needs, may also flex into the initial audit role and/or the appeals role as needed.

Qualifications

• Education: Associates or Bachelor's degree in Nursing (active/unrestricted license).
• Experience: 5+ years experience in claims auditing, quality assurance, or recovery auditing, ideally in a Clinical Validation Audit setting or a hospital environment.
• Certifications: RHIA or RHIT, Inpatient Coding Credential - CCS or CIC preferred (candidates holding a CCDS or CPC will be considered but must obtain an inpatient coding certification within 1 year of hire).
• Skills: Ability to mentor staff and enhance performance as it relates to the quality and productivity of auditors, excellent verbal and written communication skills, ability to work well in an individual and team environment, computer proficiency in Microsoft office suite required (Excel, Outlook, PowerPoint, SharePoint, etc.).

Benefits

• Base compensation ranges from $47.00 to $56.00 per hour.
• Discretionary bonus consideration available.
• Competitive benefits package including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year.