clinical auditor

IQVIA

<div><div><div>Washington, United States of America | Full time | Home-based | R1532681</div></div><div><div> 
MCRA is part of IQVIA MedTech. As a trusted CRO and advisory partner, IQVIA MedTech and MCRA deliver integrated lifecycle solutions for the medical device and diagnostics industry. Together, we support innovation from concept to commercialization, offering expertise in regulatory strategy, clinical trial design and execution, market access, and post-market optimization. Our teams combine deep therapeutic knowledge with advanced data and technology to help clients make smarter decisions and thrive in the market. Join our team to help shape the future of MedTech.</div><div>
Overview</div><div>
The Sr. Clinical QA Auditor is a critical CQA team member. We are seeking an experienced Senior Clinical QA Auditor to support and lead quality assurance activities across clinical trials within a fast-paced CRO environment. This individual will serve as a subject matter expert in GCP compliance, driving audit strategy, inspection readiness, and continuous quality improvement across sponsors, sites, and internal processes.</div><div>
Responsibilities and Duties</div><ul><li>
Lead and execute GCP audits including investigator sites, vendors, internal systems, and sponsor audits</li><li>
Plan, conduct, and report onsite and remote audits, ensuring alignment with regulatory requirements (FDA, EMA, ICH-GCP)</li><li>
Design and lead mock FDA/EMA inspections and inspection readiness initiatives for sponsors and clinical sites</li><li>
Provide onsite audit support during regulatory inspections, including hosting, documentation, and response coordination</li><li>
Provide support and guidance on GCP regulations and quality improvement initiatives.</li><li>
Perform and oversee TMF quality reviews and audits, ensuring completeness, accuracy, and inspection readiness</li><li>
Identify compliance risks, trends, and gaps</li><li>
Act as a trusted advisor to sponsors, providing strategic input on quality systems and regulatory expectations</li><li>
Contribute to the development and continuous improvement of QA processes, SOPs, and audit methodologies</li><li>
Participate in review of internal and external Quality Issues (QIs) and Corrective and Preventive Action (CAPA) plans.</li></ul><div>
Required Knowledge, Skills, and Experience</div><ul><li>
Education: Bachelor&rsquo;s degree</li><li>
Experience 5&ndash;10 years of experience in clinical quality assurance, auditing, or clinical operations within a CRO, pharma, or biotech environment.</li><li>
Medical device experience required</li><li>
Experience or exposure to global GCP regulations required</li><li>
Excellent oral and written communication skills and presentation skills</li><li>
Familiarity with ISO standards and EU GDPR regulations preferred.</li><li>
Familiarity with the Quality Management System including (but not limited to): quality training, data management, computer system validation, document control, change control, audits and inspections, quality issues and CAPA, vendor management, regulatory compliance, and all areas of GCP.</li><li>
Proficient in all MS Office applications, including Outlook and Teams.</li><li>
Experience in process improvement and project management preferred.</li><li>
Strong working knowledge of eQMS, EDC, eTMF, Document Management and SaaS systems preferred.</li><li>
Demonstrated professional oral and written communications.</li><li>
Ability to read, write, speak, and understand English fluently is required.</li></ul><div>
Travel Required: 30-40%</div><div>
IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com</div><div>
IQVIA is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable law. https://jobs.iqvia.com/eoe</div><div>
IQVIA is committed to integrity in our hiring process and maintains a zero tolerance policy for candidate fraud. All information and credentials submitted in your application must be truthful and complete. Any false statements, misrepresentations, or material omissions during the recruitment process will result in immediate disqualification of your application, or termination of employment if discovered later, in accordance with applicable law. We appreciate your honesty and professionalism.</div>
The potential base pay range for this role, when annualized, is $75,400.00 - $188,600.00. The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and welfare and/or other benefits.</div></div><div></div>

Sr. Clinical QA Auditor

Elevance Health

<div>
 
 Virtual:
 
 This role enables associates to work virtually full-time, with the exception of required inperson training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
 
 
 <ul>
 <li>
 Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
 
 
 </li>
 </ul>
 The
 
 Diagnosis Related Group Clinical Validation Auditor
 
 is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims.
 
 
 
 How You Will Make An Impact
 
 
 
 <ul>
 <li>
 Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
 </li>
 <li>
 Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.
 </li>
 <li>
 Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters.
 </li>
 <li>
 Maintains accuracy and quality standards as established by audit management.
 </li>
 <li>
 Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).
 </li>
 <li>
 Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.
 
 
 </li>
 </ul>
 
 Minimum Requirements
 
 
 
 <ul>
 <li>
 Requires current, active, unrestricted Registered Nurse license in applicable state(s).
 </li>
 <li>
 Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
 
 
 </li>
 </ul>
 
 Preferred Skills, Capabilities And Experiences
 
 
 
 <ul>
 <li>
 One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC.
 </li>
 <li>
 Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement experience preferred.
 </li>
 <li>
 Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred.
 
 
 </li>
 </ul>
 For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $81,852 to $155,088
 
 
 Locations:&Acirc; California; Colorado; District of Columbia (Washington, DC), Illinois, New Jersey; Maryland, Minnesota, Nevada; New York; Washington State
 
 
 In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.&Acirc; The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws
 
 .
 
 
 
 <ul>
 <li>
 The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
 
 
 </li>
 </ul>
 Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
 
 
 Who We Are
 
 
 Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
 
 
 How We Work
 
 
 At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
 
 
 We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
 
 
 Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
 
 
 The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
 
 
 Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
 
 
 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
 
 
 Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) .
</div>

Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)

EXL Service

<div>Job Description: Are you a skilled Outpatient Auditor with deep expertise in infusion services, complex surgeries, interventional radiology, and hospital-based outpatient care? Do you bring a strong commitment to coding accuracy, regulatory compliance, and appropriate reimbursement? If so, EXL Health is excited to welcome you to our remote auditing team!
As a Remote Certified Outpatient Auditor , you&rsquo;ll apply your in‑depth knowledge of CPT coding, outpatient regulatory guidelines, and APC reimbursement to review outpatient claims across a variety of clinical specialties. Your work will support providers, payers, and patients by validating billed CPT codes, identifying discrepancies, and ensuring adherence to industry standards.
This role is fully remote , with up to 10% annual travel for team meetings and occasional client onsite engagements.</div>
 <div><ul><li>Responsibilities: Audit outpatient claims with a focus on APC groupings, revenue codes, CPT bundling rules, and UB‑04 facility coding requirements.
</li><li>Ensure accurate documentation and coding of technical components such as nursing services, equipment use, and place of service.
</li><li>Verify that facility charges and resource utilization are coded correctly and independently from provider claims.
</li><li>Conduct detailed audits across infusion therapy, surgical services, interventional radiology, and other hospital outpatient service lines.
</li><li>Review CPT, APC, to validate correct reporting and reimbursement.
</li><li>Apply Medicare regulations, NCCI edits, CPT rules, and AHA Coding Clinic guidance to support compliance.
</li><li>Identify overpayments, coding discrepancies, and missed reimbursement opportunities.
</li><li>Utilize encoder tools (3M, Webstrat, Optum Encoder) and EXL proprietary platforms to analyze and process claims.
</li><li>Produce clear and concise audit findings aligned with official coding rules.
</li><li>Stay current on outpatient regulatory changes, reimbursement updates, and clinical practice trends across infusion, surgery, and radiology.
</li><li>Meet or exceed EXL productivity, quality, and compliance standards.</li></ul></div>
 <div>Qualifications: Required
<ul><li>Active credential(s) such as:
<ul><li>CCS
</li><li>RHIA
</li><li>RHIT
</li><li>CPC
</li><li>(Multiple credentials preferred)
</li></ul></li><li>Minimum 3 years of outpatient hospital and professional coding/auditing experience, including infusion, surgical, and interventional radiology cases.
</li><li>Strong understanding of CPT coding, APC reimbursement methodologies, and official coding guidelines.
</li><li>Familiarity with payer contracts and claim adjudication processes.
</li></ul>Preferred
<ul><li>Experience auditing complex outpatient surgical and interventional radiology cases.
</li><li>Advanced knowledge of infusion and injection coding regulations.
</li><li>Background in retrospective overpayment identification for hospital and professional claims.
</li><li>Proficiency with encoder tools (3M, Webstrat, Optum).
</li><li>Ability to work independently in a remote environment and manage multiple priorities.
</li><li>Strong written, verbal, and analytical communication skills.
</li><li>Proficiency in Microsoft Excel, Word, OneNote, and general computer applications.
</li></ul>What We Offer
Join a high-performing team at EXL Health committed to accuracy, compliance, and continuous improvement in healthcare auditing.
<ul><li>Collaborative environment: Work with experienced healthcare professionals who value your expertise.
</li><li>Ongoing professional development: Expand your knowledge across multiple specialties and coding domains.
</li><li>Mentorship &amp; career growth: Learn from senior auditors and leaders while advancing your career path.
</li><li>Work-life balance: Enjoy the flexibility of remote work with occasional travel to maintain team connection.
</li></ul>Your expertise makes a difference.
 
Join EXL Health to build your career, strengthen healthcare compliance, and make an impact across the industry.
Apply today to begin your journey with EXL Health!
Salary Range for this role is $70,000 - $80,000
0-10% travel may be required.
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits</div>

Outpatient Auditor III

Confidential

<div>
 
 We are seeking a healthcare professional with a strong medical background to support Fraud, Waste &amp; Abuse (FWA) detection, clinical audit, and Revenue Cycle Management (RCM) activities. The role focuses on identifying billing irregularities, ensuring clinical and coding compliance, optimizing reimbursement, and reducing financial leakage while maintaining regulatory and ethical standards.
 
 
 
 
 
 
 Key Responsibilities
 
 
 
 
 
 
 Fraud, Waste &amp; Abuse (FWA)
 
 
 
 
 <ul>
 <li>
 Identify, investigate, and analyze potential fraud, waste, and abuse related to medical billing, coding, and clinical documentation
 </li>
 <li>
 Conduct pre-payment and post-payment reviews of claims to detect inappropriate utilization or billing patterns
 </li>
 <li>
 Collaborate with internal teams and external stakeholders to resolve FWA cases and recommend corrective actions
 </li>
 <li>
 Prepare detailed FWA investigation reports, findings, and root cause analysis
 </li>
 <li>
 Support implementation of FWA prevention controls and compliance initiatives
 </li>
 </ul>
 
 
 
 
 Audit &amp; Compliance
 
 
 
 
 <ul>
 <li>
 Perform clinical and coding audits (IP, OP, ER, Daycare, Pharmacy, Procedures)
 </li>
 <li>
 Validate compliance with payer contracts, medical necessity guidelines, and regulatory standards
 </li>
 <li>
 Review medical records to ensure accuracy of ICD-10, CPT, HCPCS, DRG, and modifier usage
 </li>
 <li>
 Identify documentation gaps and recommend improvements to providers and coding teams
 </li>
 <li>
 Support internal, external, and regulatory audits
 </li>
 </ul>
 
 
 
 
 Revenue Cycle Management (RCM)
 
 
 
 
 <ul>
 <li>
 Review end-to-end RCM processes, including charge capture, coding, billing, and reimbursement
 </li>
 <li>
 Analyze denials, underpayments, and revenue leakage trends
 </li>
 <li>
 Work closely with billing and coding teams to optimize reimbursement and reduce denials
 </li>
 <li>
 Support payer negotiations and contract compliance reviews
 </li>
 <li>
 Ensure adherence to turnaround times, accuracy benchmarks, and KPIs
 </li>
 </ul>
 
 
 
 
 
 Required Qualifications
 
 
 
 
 
 
 Education
 
 <ul>
 <li>
 Medical background required, such as:
 </li>
 <li>
 MBBS / MD / BDS / BAMS / BHMS
 </li>
 <li>
 B.Sc. Nursing / Allied Health Sciences
 </li>
 <li>
 Additional certification in Medical Coding, Auditing, or Compliance is preferred
 </li>
 </ul>
 
 Experience
 
 <ul>
 <li>
 3&ndash;8+ years of experience in FWA, Medical Audit, or RCM
 </li>
 <li>
 Strong exposure to health insurance, TPA, hospital, or payer environment
 </li>
 <li>
 Hands-on experience reviewing medical records and claims
 </li>
 </ul>
 
 Skills &amp; Competencies
 
 <ul>
 <li>
 Strong knowledge of clinical workflows, medical necessity, and treatment protocols
 </li>
 <li>
 Proficiency in ICD-10, CPT, HCPCS, DRG, and payer guidelines
 </li>
 <li>
 Analytical skills with the ability to detect abnormal billing patterns
 </li>
 <li>
 Excellent documentation, reporting, and communication skills
 </li>
 <li>
 High ethical standards and attention to detail
 </li>
 </ul>
 
 Preferred Certifications (Optional)
 
 <ul>
 <li>
 Certified Professional Medical Auditor (CPMA)
 </li>
 <li>
 Certified Professional Coder (CPC / CCS)
 </li>
 <li>
 Certified in Healthcare Compliance (CHC)
 </li>
 <li>
 CFE (Certified Fraud Examiner) &ndash; advantage
 </li>
 </ul>
 
 Key Attributes
 
 <ul>
 <li>
 Strong clinical judgment
 </li>
 <li>
 Investigative mindset
 </li>
 <li>
 Detail-oriented and compliance-focused
 </li>
 <li>
 Ability to work independently and cross-functionally
 </li>
 </ul>
 
 
</div>

Revenue Cycle Manager

TruCare Health Services

Job Overview We are seeking a dynamic and detail-oriented Clinical Compliance Coordinator to join our healthcare team. In this vital role, you will oversee and ensure adherence to all clinical compliance standards, including HIPAA regulations, FDA guidelines, and CARF accreditation requirements. Your proactive approach will help maintain the integrity of clinical operations, safeguard patient information, and promote a culture of compliance across the organization. This position offers an exciting opportunity to make a meaningful impact on healthcare quality and safety through meticulous oversight and collaboration.Duties<ul><li>Monitor and enforce compliance with HIPAA privacy and security regulations to protect patient confidentiality and data security.</li><li>Review clinical documentation for accuracy and completeness, ensuring adherence to CPT coding, ICD-9, ICD-10, and ICD coding standards.</li><li>Collaborate with clinical staff to develop and implement policies that align with Medicare, FDA regulations, and CARF standards.</li><li>Conduct regular audits of clinical processes and documentation to identify areas for improvement and ensure regulatory compliance.</li><li>Provide training sessions on compliance topics such as ICD coding updates, Medicare requirements, and FDA guidelines.</li><li>Maintain detailed records of compliance activities, audit findings, and corrective actions taken.</li><li>Serve as a liaison between clinical teams and regulatory agencies during inspections or accreditation reviews.</li></ul>Qualifications<ul><li>Bachelor's degree in healthcare administration, health information management, or related field preferred.</li><li>Proven experience in healthcare compliance management or clinical auditing.</li><li>Strong knowledge of HIPAA regulations, CPT coding, ICD-9/ICD-10 coding systems, Medicare policies, FDA regulations, and CARF standards.</li><li>Excellent analytical skills with keen attention to detail for reviewing clinical documentation and audit reports.</li><li>Effective communication skills to train staff and coordinate with regulatory bodies.</li><li>Ability to interpret complex regulatory language into actionable procedures.</li><li>Certification in healthcare compliance or related areas is a plus. Join us in fostering a compliant environment that prioritizes patient safety, data security, and operational excellence!</li><li>Experience in healthcare, home care, or behavioral health</li><li>Strong organization and attention to detail</li><li>Ability to manage multiple priorities without dropping the ball</li><li>Comfortable using systems (Google Drive, EHR, etc.)</li></ul>Job Type: Full-timePay: From $20.00 per hourApplication Question(s):<ul><li>If you were hired, how would you organize and track?</li><li>Tell me about a time you were responsible for keeping records or files organized and compliant. What systems did you use and how did you make sure nothing was missed?</li></ul>Education:<ul><li>Associate (Preferred)</li></ul>Work Location: In person

Clinical Compliance Coordinator

Integra Partners

<div>The Clinical Quality Analyst is responsible for monitoring, auditing, and documenting both clinical and non-clinical production quality in support of departmental goals and organizational standards. This role evaluates clinical documentation and decision-making across operational areas that require regulatory oversight, client-specific requirements, and compliance with medical policy, with an emphasis on accuracy, completeness, documentation quality, adherence to clinical and operational guidelines, and alignment with applicable regulatory and client standards. As needed, the role also performs non-clinical audits, including reviews of customer service interactions, system documentation, claims, administrative workflows, and other operational processes.
The Clinical Quality Analyst participates in the development of quality monitoring formats and standards, ensuring fair and consistent evaluation practices across clinical and operational functions. This role provides clear, constructive feedback to team members and leadership, supports coaching efforts, and collaborates cross-functionally to identify trends, recommend solutions, and drive continuous improvement. The Clinical Quality Analyst documents audit results, prepares quality reports, and facilitates discussions with stakeholders to support service excellence and operational effectiveness across the organization 
 
 JOB QUALIFICATION: KNOWLEDGE/SKILLS/ABILITIES 
The Clinical Quality Assurance Analyst responsibilities include but are not limited to:
<ul><li>Audit clinical reviews and documentation, including medical necessity determinations, regulatory compliance, and adherence to medical policy
</li><li>Ensure adherence to clinical guidelines, payer policies, and industry standards (NCQA, URAC, CMS, state and federal regulations.)</li><li>
Complete and document audits using standardized quality monitoring tools
</li><li>Collaborate with clinical and operational leadership, as well as training teams, to support targeted coaching, process improvement, and the development of content-based training that equips personnel with the skills needed for success
</li><li>Maintain compliance with HIPAA and confidentiality requirements
</li><li>Support special audits, regulatory readiness activities, and ad hoc analysis requests
</li><li>Perform non-clinical audits as needed &middot; Participate in and support the design of quality monitoring forms and quality standards
</li><li>Record evaluations utilizing departmental quality monitoring forms
</li><li>Collect, evaluate, report on, and track operational data against performance metrics
</li><li>Prepare and analyze quality reports for management review
</li><li>Prepare and facilitate quality calibration sessions with designated department leads
</li><li>Facilitate meetings and prepare presentations related to insight analysis
</li><li>Monitor trends and provide input or feedback on the information reported on
</li><li>Identify, analyze, and share ways to optimize the quality monitoring process
</li><li>Complete all evaluations, reports, and employee coaching sessions on a timely basis
</li><li>Ability to learn new systems, tools, and methodologies as needed and continue progressing in a dynamic environment
</li><li>Support ad hoc quality monitoring, reporting, and analysis activities based on operational needs
</li><li>Work and communicate cross-departmentally</li></ul><div>
QUALIFICATIONS:<ul><li>
Active, unrestricted LPN/LVN or RN license</li><li>
Minimum 2 years of experience in Utilization Management or related clinical operations in a healthcare or managed care setting</li><li>
Minimum of 1 year of experience performing Quality Assurance in a call center or other production-oriented service operations environment (or equivalent education and experience)</li><li>
Strong knowledge of clinical review processes, regulatory requirements, and medical necessity criteria (e.g., InterQual, MCG)</li><li>
Familiarity with UM software platforms and audit tools</li><li>
Proficient understanding of QA methodologies and quality monitoring practices</li><li>
Demonstrated ability to rapidly gain product, process, and tools knowledge and effectively communicate it to employees</li><li>
Ability to analyze data to identify root causes of quality issues and propose actionable solutions</li><li>
Excellent communication skills including listening, interpersonal, verbal, written, spelling, and grammar</li><li>
Ability to coach/motivate employees with tact in order to facilitate optimal performance</li><li>
Must exhibit leadership capabilities and interpersonal skills</li><li>
Maintain confidential information and abide by necessary rules and regulations</li><li>
Strong organizational, problem-solving, and analytical skills</li><li>
Manage conflicting priorities while clearly communicating and managing expectations</li><li>
Proficiency in Microsoft Office (Word, Excel, PowerPoint) for presentations and reports</li><li>
Flexible and able to multitask and work with changing priorities with enthusiasm</li><li>
Self-motivated, detail-oriented, and prepared to work independently or as an active team player</li><li>
Ability to remain focused and motivated during the auditing process</li><li>
Consistent track record of 95%+ in Quality and Production scores in current/previous roles</li><li>
Experience conducting clinical or non-clinical audits or quality assurance reviews</li></ul>
What will you learn in the first 6 months?<ul><li>
You will learn the function of the Quality Assurance team within the Operations organization.</li><li>
You will fully understand your job role and responsibilities and which tools assist you in your position</li><li>
Familiarized with Integra&rsquo;s QA platform (Genie) and how to navigate through it. Including how to adjudicate an audit appeal</li><li>
Comprehensive understanding of Integra&rsquo;s Utilization Management workflows and QA processes</li><li>
Subject matter expert in the Policy and Procedures for the department you audit</li><li>
During this time, you will set measurable goals for personal development and growth.</li></ul>
What will you achieve in 12 months?<ul><li>
You will be fully integrated with your job, company and team.</li><li>
You will be contributing your skills and knowledge to meeting your department's goals.</li><li>
You will become confident in leading meetings with Interdepartmental Management teams and presenting complex concepts related to quality analysis</li></ul>
EDUCATION:<div>
Bachelor&rsquo;s degree in nursing</div><div>
Healthcare Quality Certification (e.g., CPHQ) or willingness to obtain within 12 months 
 
Salary: 70,000/Annually</div></div> 
Benefits Offered
<ul><li>Competitive compensation and annual bonus program</li>
<li>401(k) retirement program with company match</li>
<li>Company-paid life insurance</li>
<li>Company-paid short term disability coverage (location restrictions may apply)</li>
<li>Medical, Vision, and Dental benefits</li>
<li>Paid Time Off (PTO)</li>
<li>Paid Parental Leave</li>
<li>Sick Time</li>
<li>Paid company holidays and floating holidays</li>
<li>Quarterly company-sponsored events</li>
<li>Health and wellness programs</li>
<li>Career development opportunities</li>
</ul>
Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We&rsquo;re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don&rsquo;t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.
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Clinical Quality Assurance Analyst

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Sr. Clinical QA Auditor

Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)

Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)

Outpatient Auditor III

Revenue Cycle Manager

Clinical Compliance Coordinator

Clinical Quality Assurance Analyst