AmeriHealth Caritas · 2 days ago
Supervisor Quality Auditing (Provider Audit)
Philadelphia, PA
Full-time
Hybrid
Mid Level
3+ years expAmeriHealth Caritas is a mission-driven organization with over 30 years of experience in healthcare solutions. They are seeking a Quality Auditing Team Lead to oversee daily operations of the Quality Auditing department, ensuring provider audit accuracy and compliance with regulatory requirements while leading various audit types.
Health CareInformation Technology
Responsibilities
Lead and manage provider‑focused audits, including Provider Performance audits, Compliance audits, Enterprise Operations reviews, Pre‑Production audits, and targeted provider audits
Apply extensive knowledge of provider billing rules, reimbursement methodologies, documentation requirements, policies, and contract provisions across multiple lines of business; communicate trends and findings clearly
Oversee the Quality Auditing appeals process related to provider issues, including documentation, tracking, decision-making, and resolution guidance
Develop, refine, and implement audit protocols, provider audit procedures, and operational strategies to strengthen provider oversight and accuracy
Identify trends, system issues, or operational gaps impacting provider data quality, claims accuracy, or audit outcomes; provide analysis and actionable recommendations to leadership
Coordinate provider audit inventory, task assignments, and special projects to support timely and accurate audit completion
Coach team members to enhance provider audit accuracy, documentation quality, and professional development
Represent the Quality Auditing department in meetings with internal stakeholders, Provider Network teams, and cross‑functional initiatives impacting provider performance and quality
Professionally respond to inquiries regarding provider audits, provider billing or documentation findings, appeals, and special project reviews
Maintain comprehensive and compliant provider audit documentation per retention and regulatory standards
Report issues related to provider audit tools, platforms, or supporting systems (e.g., Online Help, Facets, IAD)
Qualification
Required
Bachelor's Degree or equivalent professional experience
Minimum 1 year of internal quality or provider auditing experience
Minimum 3 years of healthcare industry experience, preferably in provider operations, provider relations, or claims
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint); Access preferred
Strong analytical and problem‑solving skills, with emphasis on provider documentation review, billing accuracy, trend identification, and policy alignment
Excellent communication, leadership, and collaboration skills, especially when working across provider‑facing teams
Benefits
Flexible work solutions include remote options
Hybrid work schedules
Competitive pay
Paid time off
Holidays and volunteer events
Health insurance coverage for you and your dependents starting Day 1
401(k) retirement savings plan
Tuition reimbursement
And more.
Company
AmeriHealth Caritas
AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.
10001+ employees
H1B Sponsorship
AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (18)
2024 (17)
2023 (12)
2022 (14)
2021 (4)
2020 (11)
Funding
Current Stage
Late StageLeadership Team
Kathleen Giblin
SVP Clinical Operations
Ash Hanson
Executive Vice President & Chief Human Resources Officer
Recent News
2025-11-06
The Philadelphia Inquirer
2025-10-02
2025-10-01
Company data provided by crunchbase