Provider Network Quality Assurance Specialist

📋 Description

• Develop and maintain a structured audit schedule for provider network operations, ensuring reviews
• Conduct research, analyze operational data, and recommend improvements to address administrative
• Maintain complete audit evidence and records to support internal reviews, external audits
• Evaluate provider directory accuracy and document review findings and follow-up activities in
• Compare published provider directory information with source systems, coordinating provider
• Prioritize corrections that could affect member access to care, directory search results, or

🎯 Requirements

• Bachelor's degree from an accredited college or university in Human Services, Sociology
• At least five years of relevant experience performing quality assurance or quality improvement
• Demonstrated experience leading project teams focused on quality improvement initiatives.
• Advanced proficiency in Microsoft Office applications, particularly Excel, including the ability to
• Strong analytical and problem-solving skills, with the ability to identify data discrepancies
• Excellent written and verbal communication skills, including the ability to prepare clear audit

🎁 Benefits

• Annual salary range: $69,592–$88,729, with final compensation determined by education, experience
• Healthcare coverage: Medical, dental, and vision insurance.
• Additional protection: Life insurance and long-term disability coverage.
• Retirement: A comprehensive retirement savings plan.
• Work flexibility: Flexible work schedules, including remote and hybrid options, subject to role
• Paid time off: Vacation, sick leave, holidays, and management leave.