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Qlarant · 1 day ago

Auditor/Investigator II

United States

Full-time

Remote

Mid, Senior Level

$56K/yr - $84K/yr

2+ years exp

Qlarant is a not-for-profit corporation focused on enhancing healthcare and human services delivery. The Auditor/Investigator II role involves monitoring electronic medical records and supporting research related to prepay and post-pay claims, while ensuring quality assurance and effective communication with external contractors.

Information ServicesInformation Technology

Responsibilities

Monitors QMS procedures, work instructions, and job aids. Provides first level review for changes

Supports problem-solving solutions for system issues

Provides expertise for implementing, deactivation, monitoring, quality assurance, and reporting of prepay edits

Facilitates meetings and coordinates presentations

Tracks and analyzes data and reports for prepay committee edit effectiveness; creates presentations

Assigns incoming and outgoing external contractor communications; monitors completion of requests

Researches prepay and post-pay record questions. Reports quality assurance for appeal requests, recalculations, and redeterminations

Schedules coordination of ad hoc calls with external contractors or law enforcement; takes minutes

Reviews and comments on Medicare JOAs

Creates templates and content for the external contractor annual fraud and abuse training

Qualification

Healthcare InvestigationMedicare ExperienceCertified Fraud ExaminerData AnalysisQuality AssuranceProblem SolvingPresentation SkillsCommunication Skills