Quality Assurance Spec

Location: Remote within the United States; G.E.H.A does not hire from U.S. territories or Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, or Maine.

Salary: $47,808–$60,480 USD target hiring range; maximum current salary of $67,392 USD.

Company

hirify.global is a nonprofit member association providing health and dental benefits to federal employees, retirees, military retirees, and their families.

What you will do

• Audit claims coding, customer service calls, electronic files, provider records, and related quality processes.
• Prepare daily, monthly, and annual reports and analyze audit reports and rebuttals to identify trends and determine outcomes.
• Manage complex provider issues and correspondence while answering questions from Provider Data Management staff and other departments.
• Perform credentialing, provider verification, provider relations, call, case, service issue, contract, and file audits.
• Recommend improvements to workflows, policies, procedures, training materials, and desk-level processes.
• Support department training and contribute independently and collaboratively to cross-functional projects.

Requirements

• Associate's degree required; additional experience may be considered in lieu of a degree.
• Four years of related experience required.
• Effective written and verbal communication skills for working with staff and providers.
• Proficiency with Microsoft Word and Microsoft Excel.
• Thorough knowledge of Provider Data Management policies and procedures.
• For remote work, a dedicated interruption-free home office and non-cellular high-speed internet are required; minimum speed is 30 Mbps download and 5 Mbps upload, with latency below 80 ms. Hotspots, satellite, and wireless internet are not allowed.

Nice to have

• Experience as an Associate Quality Assurance Specialist within Provider Data Management.

Culture & Benefits

• Remote work opportunity with flexibility and a focus on work-life balance.
• Health, vision, and dental benefits effective on the first day.
• 401(k) plan with dollar-for-dollar matching up to a 4% employee contribution and a 6% annual company contribution.
• Paid time off, personal community enrichment time, and an employee well-being program.
• Company-provided life, accidental death and dismemberment, short-term disability, and long-term disability coverage.
• Incentive plan and tuition assistance program.