What are the responsibilities and job description for the Senior Quality Auditor position at VirtualVocations?
A company is looking for a Senior Quality Auditor to develop and implement effective business solutions through research, audit, and analysis of data and business processes.Key ResponsibilitiesAudit and validate routine pre and post payment claims for compliance with policies and regulatory guidelinesPerform routine and moderately complex audits on medical review claims to identify exceptionsResearch claims issues to determine origins and appropriate resolutions, summarizing findings in reports for managementRequired QualificationsHigh School Diploma or equivalent; some college coursework preferredFour years of general data management experience in claims processing or provider maintenanceKnowledge of health insurance industry regulations and certification standardsExperience with auditing provider data and claims processing systemsAbility to maintain current knowledge of relevant products, policies, and procedures
