- Conducts quality assurance audits for all Lines of Business.
- Conducts quality assurance audits for claim adjustments, refunds and provider disputes.
- Performs routine and moderately complex claim audits for payment accuracy in accordance with regulatory standards, and business policies.
- Participates in some special projects/work.
- Participates in the appropriate and approved training classes during year (in accordance with goals).
- Demonstrates awareness of work required at next level and working at that standard.
- Works on problems of moderate scope where analysis of situations and / or data requires review of variety of factors.
- Exercises good judgment within defined procedures and practices to determine appropriate action.
- Builds productive working relationships internally and externally.
- Presents ideas assertively and directly, providing data to support conclusions.
- Adapts ideas and ties them to the needs and goals of others to gain their support and commitment.
- Applies knowledge of internal and external regulatory processing guidelines.
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Quality Auditor
2 weeks ago
HydraFacial Long Beach, United States Full timeDescription · : Hydrafacial, a leading medical device company, seeks a detail-oriented and experienced Auditor to join our Quality Assurance team. The ideal candidate will be responsible for conducting internal audits, preparing for external audits, and auditing suppliers to ens ...
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Quality Auditor
3 weeks ago
SQA Services Los Angeles, United StatesSQA is a leading Quality Assurance and Supply Chain solutions firm. SQA manages Supplier Audit and Supplier Development programs for clients in quality-critical industries, including Pharmaceutical, Medical Device, Automotive, Aerospace, and Electronics manufacturing. Clients lev ...
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Quality Auditor
3 days ago
AFL Los Angeles, United StatesThe Quality Auditor will be responsible for attending/auditing telecommunication sites (Central Office) where they will ensure completed builds (both upgrades and new installations, active and passive elements) have been installed/constructed in accordance with the site design an ...
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Quality Auditor
5 days ago
BeautyHealth Long Beach, United StatesAbout Us · BeautyHealth is a global category-creating company focused on bringing innovative products to market and delivering beauty health experiences by reinventing our consumer's relationship with their skin, their bodies and their self-confidence. · Every person here is a ...
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Kaiser Permanente Downey, United StatesJob Summary: · Remote from any KP location in CA, OR, CO, WA, GA, MD, VA, HI or D.C. Only. · ** PLEASE NOTE: Salary ranges are geographically based and the posted range reflects the Southern CA region. Applicable salary ranges will apply for other labor markets outside of SCAL. ...
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Claims Quality Auditor
2 days ago
UCLA Health Los Angeles, United StatesTake on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health. · The Claims Quality Auditor will b ...
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Quality Assurance Auditor
3 weeks ago
Patco Brands Los Angeles, United StatesPatco Brands is one of the fastest growing beverage companies in the United States. Independently owned, Patco has established itself by using 100% Blue Weber Agave and a proprietary process to innovate within the fast growing ready-to-drink spirits category. · Patco is a maker ...
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Claims Quality Auditor
6 days ago
UCLA Health Los Angeles, United StatesGeneral Information · Press space or enter keys to toggle section visibility · Work Location: Los Angeles, USA · Onsite or Remote · Flexible Hybrid · Work Schedule · Monday - Friday, 7:00am - 3:30pm PST · Posted Date · 01/30/2024 · Salary Range: $ Hourly · Employment Type · 2 - S ...
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Claims Quality Auditor
6 days ago
University of California Los Angeles, United StatesTake on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health. · The Claims Quality Auditor will be ...
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Claims Quality Auditor
1 day ago
University of California Los Angeles, United StatesTake on an important role within a world-class health organization. Provide specialized expertise that enables the efficient operation of a complex health system. Take your career to the next level. You can do all this and more at UCLA Health. · The Claims Quality Auditor will b ...
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Quality Assurance Auditor
3 weeks ago
Altasciences Cypress, United StatesYour New Company · At Altasciences we all · move in unison to assist and work in the discovery, development, and manufacturing of new drug therapies to get them faster to people who need them.No matter your role, we all play an important part and you will have a significant impa ...
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Performance Quality Auditor I
1 week ago
Elevance Health Los Angeles, United States Full timeJob Description · : Performance Quality Auditor I · Location: This is a remote position. The ideal candidate will live within 50 miles of an Elevance Health PulsePoint office location. · The Performance Quality Auditor I is responsible for evaluating the quality of services ...
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Quality Assurance Auditor
3 weeks ago
Key Skilled San Fernando, United StatesJob Description · Job DescriptionQuality Assurance AuditorLocation: Sun Valley, CA, USShift: Monday – Friday, 1st shift 8:00 am – 5:00 pm Salary Range: $53,500.00 To 74,800.00 Annually Seeking a Quality Assurance Auditor to support its Quality Assurance department. Selected appl ...
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Quality In-Process Auditor
3 weeks ago
Optimax Systems Inc. Ontario, United StatesJob Description · Job DescriptionQuality In-Process Auditor · C-shift (11:00pm - 7:30am) · Minimum 35 hrs/week; overtime as needed · CHECK OUT BELOW TO SEE WHY YOU SHOULD WORK FOR OPTIMAX · Optimax has lenses throughout the Universe We build the optics behind the latest breakthro ...
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Intermediate Medical Claims Quality Auditor II
3 weeks ago
Kaiser Permanente Downey, United StatesJob Summary: · Remote from any KP location in CA, OR, CO, WA, GA, MD, VA, HI or D.C. Only. · ** PLEASE NOTE: Salary ranges are geographically based and the posted range reflects the Southern CA region. Applicable salary ranges will apply for other labor markets outside of SCAL. ...
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Quality Auditor
1 month ago
Skyryse El Segundo, United States Full timeABOUT SKYRYSE: · Skyryse wants to empower anyone, to fly anywhere, in any aircraft, safely and as a highly experienced pilot would. Powered by SkyOS, we automate flight controls and systems management to achieve unmatched safety and eliminate opportunities for human error. We wan ...
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GMP Quality Assurance Auditor
3 weeks ago
SciPro Inc. Los Angeles, United States FreelanceWe are looking for an experienced QA Auditor, to audit suppliers and CDMO's for a CAR-T Biotech client in California. This role will be to support a few small audits, however, we are looking for someone that has capacity to work with a number of other clients as we are seeing a d ...
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Claims Quality Auditor
2 weeks ago
UCLA Health Los Angeles, United StatesGeneral Information · Press space or enter keys to toggle section visibility · Work Location: Los Angeles, USA · Onsite or Remote · Flexible Hybrid · Work Schedule · Monday - Friday, 7:00am - 3:30pm PST · Posted Date · 01/30/2024 · Salary Range: $ Hourly · Employment Type · 2 - S ...
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Quality Assurance Auditor
3 weeks ago
Patco Brands Los Angeles, United StatesPatco Brands is one of the fastest growing beverage companies in the United States. Independently owned, Patco has established itself by using 100% Blue Weber Agave and a proprietary process to innovate within the fast growing ready-to-drink spirits category. · Patco is a maker ...
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Quality Assurance Auditor
3 weeks ago
24 Seven Talent Los Angeles, United StatesOur beverage client is looking to bring on a Quality Assurance Auditor to their team on a fulltime basis, sitting in California or on the West Coast as this role will require travel. · Responsibilities: · Travel to all production and co-manufacturing facilities on a regular bas ...
Intermediate Quality Auditor II - Downey, United States - Kaiser Permanente
Description
Job Summary:Remote from any KP location in CA, OR, CO, WA, GA, MD, VA, HI or D.C. Only.
** PLEASE NOTE: Salary ranges are geographically based and the posted range reflects the Southern CA region. Applicable salary ranges will apply for other labor markets outside of SCAL.
Quality Claims Auditor: This position exists to ensure the integrity of medical payments for the organization through verification of the accuracy of data-entered information and by auditing service related information and invoice adjudication/payment for compliance with contract terms and Department/Regional policy and procedures.
The auditor must be proficient with the medical systems, claims processing and adjudication. The position requires research, problem resolution and specialized knowledge in the areas of benefits, contracts, Medicare, Medicaid, Coordination of Benefits and Third-Party liability, WebStrat, Multiplan, Beechstreet and other pricers.