Qlarant · 1 day ago
Auditor/Investigator II
United States
Full-time
Remote
Mid, Senior Level
$56K/yr - $84K/yr
2+ years expQlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. The Auditor/Investigator II role involves monitoring electronic medical records processing, supporting research on claims, and ensuring quality assurance for prepay edits and appeals.
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
Required
Minimum Bachelor's Degree required
2 - 4 years of experience required
Healthcare Investigation experience required
Preferred
5 - 7 years of experience preferred
Medicare experience preferred
Certified Fraud Examiner preferred
Company
Qlarant
Qlarant is a not-for-profit, nationally respected in fighting fraud, waste, and abuse—improving program quality, and optimizing performance.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Christine Leister
Chief Financial Officer
Recent News
2025-12-04
PR Newswire
2025-09-17
Qlarant Foundation
2025-07-15
Company data provided by crunchbase