Quality Assurance Analyst (Healthcare)

TL;DR

Quality Assurance Analyst (Healthcare): Performing non-clinical quality audits of transactions to ensure regulatory compliance and adherence to contractual performance guarantees with an accent on claims processing and utilization management. Focus on identifying accuracy gaps in billing and enrollment systems and validating source documentation to ensure operational quality.

Location: Working at Home - Pennsylvania

Company

hirify.global is a major healthcare organization providing health insurance and clinical services.

What you will do

• Perform comprehensive reviews and analysis of transactions to ensure accuracy and compliance with regulatory and contractual obligations.
• Manage an individual audit case inventory to consistently meet departmental production and quality standards.
• Document audit findings and communicate them effectively to internal and external customers.
• Validate source documentation to ensure it is complete and accurate in accordance with reporting requirements.
• Stay updated on current guidelines and operational procedures via the Knowledge Center and other corporate resources.

Requirements

• High School Diploma or GED.
• 3 years of experience in Claims Support and Processing, Customer Service, Billing, Enrollment, Benefits Administration, or Utilization Management.
• Must be based in Pennsylvania (Working at Home - PA).
• Proficiency in auditing claims processing, billing, and enrollment systems.

Nice to have

• Bachelor's Degree in Business Administration, Management, Accounting, Health Administration, or General Studies.

Culture & Benefits

• Flexible work arrangement allowing for working from home within Pennsylvania.
• Professional environment adhering to strict ethical, legal, and behavioral standards.
• Focus on data security and compliance with HIPAA regulations.