Quality Control Auditor

At RAM Health, our mission is to simplify the complexities of healthcare administration through innovative, technology-driven solutions. With a focus on changing the industry one plan at a time, we drive continuous innovation to help government-sponsored health plans improve performance and quality while reducing costs.  

RAM Health - Health plan administration, simplified.

The Quality Control Auditor will complete standard functional pre and post transaction outcome reviews to determine the accuracy and compliance of each transaction. This role will be responsible for staying current on expected operational outcomes and aligning each quality review against the appropriate process, contractual service-level agreements, and compliance guidelines in place at the time of processing. The candidate must ensure clearly documented details regarding the outcome of each audit and must work with operational delivery to provide feedback aimed at identifying root cause and corrective action steps. The specialist must have excellent problem-solving skills, along with keen attention to detail and outstanding written and oral communication abilities.

Requirements and Responsibilities

The Quality Control Auditor audits for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. They select audits through random processes and/or other criteria. The Quality Control Auditor makes recommendations to improve quality, workflow processes, policies, and procedures. This role typically requires an associate degree and reports to a supervisor or a manager. The Quality Control Auditor contributes to moderately complex aspects of a project and works independently and collaboratively in nature.

• Perform quality reviews of random and/or targeted periodic audits
• Document outcomes of each quality audit
• Aid in identification of compliance risks, root cause analysis, and corrective action steps to address findings
• Collaborate with operations to drive continuous quality improvement initiatives

Industry: 2+ years in healthcare industry experience working in the payer segment in Medicare Advantage, Managed Medicaid, or working with an industry competitor. Experience in BPaas environment is a plus.

Skills & Knowledge: Candidate should have experience in performing and documenting quality reviews of healthcare transactions. Attention to detail and the ability to work under time constraints are also required. MS PowerPoint, MS Word, MS Excel, MS Access. Exceptional interpersonal, listening, written and oral communication abilities a must. Experience in review of system configuration is a plus.

Compensation and Benefits

• 100% remote work culture
• Health, dental & vision insurance
• 5 weeks' vacation and holiday pay
• Traditional and ROTH 401k with company match
• Company paid life insurance, AD&D, and long-term disability coverage
• HSA and FSA accounts
• Tuition Reimbursement
• Parental Leave

This is a U.S.-based remote position. Employees must perform all work while physically located within the United States. Working from outside the United States is not permitted. 

Compliance: All employees shall comply with company policies, including those related to security and privacy, as well as with applicable laws and regulations such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, and other relevant federal and state regulations.

Data Protection: Employees are responsible for safeguarding protected health information (PHI) and personally identifiable information (PII) in accordance with company policies and HIPAA regulations. This includes ensuring that all data is accessed, processed, stored, and transmitted securely.