Hybrid Quality Assurance Auditor

at Independent Health

• Job title: Quality Assurance Auditor
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $24 - $27 per hour
• Degree requirement: High School Diploma
• Location requirements: Hybrid, Buffalo, United States

About the role

• Quality Assurance Auditor performing quality assurance audits for Pharmacy Benefit Dimensions. Ensuring compliance with regulatory requirements and collaborating with teams for effective audit processes.

Responsibilities

• Perform monitoring, oversight, and quality assurance reviews/audits of all lines of business as defined by CMS, NYS DOH, NYS DFS and any/all policies and procedures established (as applicable) for assigned operational areas.
• Ensure the quality and accuracy of the systems and processes that support the organization’s operation to meet client government regulatory requirements and compliance plans.
• Track issues identified during the quality assurance process to ensure resolution.
• Analyze, document, and report on results to business stakeholders and company leaders.
• Collaborate with the Quality Assurance team and other cross functional teams to remediate audit findings, to develop and improve testing and audit strategies, techniques, activities, policies and procedures.
• Conduct internal audits to measure and ensure adherence to claims processing standards, technical requirements, supporting processes, systems, and required program documentation.
• Report quality assurance and audit results to management and leadership teams.
• Perform ad hoc queries in audit database in support of decision making.

Requirements

• High school diploma or GED required.
• Associates degree preferred.
• Three (3) years of experience in quality assurance/quality control, compliance monitoring, pharmaceutical, or managed care environment required.
• Experience with Medicare, Medicaid or another government program strongly preferred.
• Experience with pharmacy on-line claims processing systems preferred.
• Strong analytical, problem solving, time management and organizational skills.
• Ability to use independent judgement and solid reasoning skills when rendering decisions and troubleshooting issues.
• Detail oriented, while maintaining an awareness of overall goals.
• Experience with AS400 query or other query tools.
• Ability to easily learn new software applications.
• Experience in report production.
• Ability to maximize use of system capabilities to lead the organization in outcome improvement.
• Excellent interpersonal, written and verbal communication skills.
• Proven examples of displaying PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Benefits

• full range of benefits
• generous paid time off
• scorecard incentive