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Career Opportunities: Quality Assurance Specialist (24455) Requisition ID 24455 - Posted 07/26/2024 - CareOregon - Full Time - Permanent - Portland - Multi Location (9) Job Description Print Preview Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Quality Assurance Specialist Department Clinical Operations Exemption Status Non-Exempt Requisition # 24455 Direct Reports N/A Manager Title Quality Assurance Manager - Operations Pay & Benefits Estimated hiring range $57,560 - $70,360/year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This role is fully remote but must reside in one of the listed 9 states. Job Summary This position is responsible for supporting operations through Quality Assurance (QA) practices and oversight of operations functions. The position performs quality audits, conducts feedback sessions and other QA functions for operations staff. Specific areas of focus include Claims, Payment Integrity, Enrollment, Clinical Operations, Mailroom and/or other areas of operations. Essential Responsibilities Perform routine and complex audits on individual, vendor, random, trainee and focused audits to identify exceptions to established internal processes and regulatory or contractual requirements. Assist the department in identifying ways in which quality and productivity can be improved and rework minimized. Support fraud and abuse audits. Perform first level audit based on reports and conduct pre-check run audits for claims, enrollment, and/or clinical operations. Perform audits on third-party vendors to ensure quality and make recommendations to internal managers and supervisors on areas for improvement in third-party vendor processes. Research claim, enrollment, and/or clinical operations processing problems and errors to determine their origin and appropriate resolution. Develop and provide CCO summary level reports and individual staff quality reports to leadership. Support leaders in external and internal audits, including data validation for preparation of audit universes. Identify proactively through auditing and internal reporting, any trends and initiate recommendations for remediation. Analyze data processing reports and make necessary corrections or adjustments. Participate in training and processing activities to stay up to date on processing procedures. Assist with training of staff as needed. Assist manager with follow-up on any problems or questions related to the audit results or corrective action plans. Develop, implement, and coordinate audit and support fraud and abuse prevention programs and procedures. Create appropriate spreadsheets to store all data from audits and analyze data to create reports from spreadsheets. Work collaboratively with other departments and management to ensure ongoing audits are effective, continually improved upon and meet organizational needs. Independently manage special projects as assigned. Organizational Responsibilities Perform work in alignment with the organization's mission, vision, and values. Support the organization's commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals. Strive to meet annual business goals in support the organization's strategic goals. Adhere to the organization's policies, procedures, and other relevant compliance needs. Perform other duties as needed. Knowledge