Operations Auditor (Managed Care)

Location: Fully remote; candidates must reside in Kansas. Candidates residing in Kansas City, Missouri, are also eligible. Standard schedule is Monday through Friday, 8:00 AM–5:00 PM CST.

Salary: $56,200–$101,000 per year.

Company

hirify.global is a diversified national healthcare organization serving 28 million members.

What you will do

• Audit group setups, contract changes, terminations, system entries, performance metrics, and operational processes.
• Design and manage data review processes to maintain the accuracy and integrity of PDM and credentialing reports.
• Conduct risk-based audits of controls and processes for scalability, efficiency, and risk mitigation.
• Compile audit findings, metrics, graphs, and recommendations for management.
• Coordinate corrective actions and create educational materials related to audit errors.
• Examine information systems, recommend reliability and data-integrity controls, and resolve data-load issues.

Requirements

• Bachelor’s degree in a related field or equivalent experience.
• At least 3 years of auditing or process improvement experience.
• Knowledge of state contract and accreditation requirements.
• Ability to research regulatory requirements, identify operational risks, and recommend process improvements.
• Strong attention to detail, organization, time management, and ability to work independently in a remote environment.
• Residence in Kansas or eligibility from Kansas City, Missouri is required.

Nice to have

• Experience in managed care, LTSS, home- and community-based services, case management, HEDIS, or KDADS-related audits.
• Experience auditing case files, reviewing documentation, identifying trends, and recommending improvements.

Culture & Benefits

• Fully remote work with a fixed CST business-hours schedule.
• Health insurance, 401(k), and stock purchase plans.
• Tuition reimbursement, paid time off, and holidays.
• Flexible workplace options across remote, hybrid, field, and office schedules.