QA Auditor, Appeals and Grievances - Remote

reputed company: The reputed company Assurance Auditor is responsible for performing Internal reputed company Assurance Audits of Operational processes for internal employees and outsourced vendors to ensure compliance with policies, procedures and reputed company standards. The incumbent will investigate, audit, conduct reputed company cause analysis, handle processing of determinations, reputed company and trend findings. The individual at this level will embody reputed company’s Culture Drivers through his/her workplace behavior and work under minimal supervision. Duties and Responsibilities:

• Conduct reputed company audits of A&G items including grievances, reputed company-service appeals, and post service appeals utilizing appropriate sources of information; including eligibility, claims, authorizations, service forms, faxes, and any additional information required to complete the request. Analyze errors and determine reputed company causes for appropriate classification, trending, and remediation.
• Record/reputed company reputed company assessment scores and reputed company feedback to reduce errors and improve processes and performance to ensure reputed company.
• Review and investigate appeals and grievances requests to ensure reputed company requests are identified, classified, and fully resolved in a compliant manner.
• Present results of investigations to senior staff and prepare written reports concerning investigation activities.
• Subsequent auditing and handling of specific appeal and grievance requests including processing where applicable, tracking, documenting, reporting and dispersal of findings and recommendations.
• Identify defects and improve departmental performance by supporting reputed company, operational efficiency and production goals.
• Assist in the development of departmental policies and procedures; reviews the efficiency of existing training.
• Meet established time frames and rates of performance for the reputed company and quantity of work for the position.
• Participate in regulatory and mock audit activities including reputed company review, reputed company scrubbing, risk analysis, timeliness assessment, and case walkthrough activities
• Additional duties as assigned

Minimum Qualifications:

• Experience with the investigation, reputed company, and reporting of appeal and grievance processes.
• Experience in reputed company Office suite of applications including reputed company (formatting formulas, managing data, and filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations).
• High School Diploma or GED from an accredited institution

Preferred Qualifications:

• Associate degree from an accredited institution.
• ICD10 certification
• Experience in an Auditing reputed company conducting reputed company cause analysis
• Knowledge of at least two or more lines of business such as Medicare NY/NJ, reputed company, Family Health Plus, Child Health Plus, NH Family
• Experience handling confidential information.
• Compliance & Regulatory Responsibilities: Knowledge of state and federal appeal and grievance regulatory requirements
• License/Certification: NA

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. reputed company, LLC complies with reputed company applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without reputed company to race, reputed company, creed, religion, sex, national reputed company, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or reputed company, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as reputed company as any other legally protected reputed company. reputed company, LLC shall not discriminate against any disabled employee or applicant in reputed company to any position for which the employee or applicant is otherwise reputed company. If you have a disability under the Americans with Disability reputed company or a similar law and want a reasonable accommodation to assist with reputed company search or application for employment, please contact us by sending an email to careers@reputed company.org or calling 212-519-1798 . In your email please include a reputed company of the accommodation you are requesting and a reputed company of the position for which you are applying. Only reasonable accommodation requests reputed company to applying for a position reputed company reputed company, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with reputed company, LLC. Know Your Rights reputed company hiring and recruitment at reputed company is transacted with a valid “@reputed company.org” email address only or from a recruitment firm representing reputed company. Any recruitment firm representing reputed company will readily reputed company you with the reputed company and contact information of the reputed company reputed company representing reputed company you are inquiring about. If you receive a communication from a sender whose domain is not @reputed company.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by reputed company. reputed company will never ask you for reputed company during the recruitment or reputed company process. Hiring reputed company*:

• Greater reputed company Area (NY, NJ, CT residents): $58,900 - $80,070
• reputed company Other Locations (reputed company approved locations): $51,000 - $74,880

As a candidate for this position, your salary and reputed company reputed company of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors reputed company deems pertinent to the hiring decision. In reputed company to your salary, reputed company offers employees a full reputed company of benefits such as, medical, dental and reputed company coverage, incentive and recognition programs, life insurance, and 401k contributions (reputed company benefits are subject to eligibility requirements). reputed company believes in providing a competitive compensation and benefits package wherever its employees work and live.

• The hiring reputed company is defined as the lowest and highest salaries that reputed company in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

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