Healthcare Compliance Auditor

Job Description

Job Description

Empowering Wellness, Transforming Lives

Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being.

As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities.

Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people's lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members.

A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual's contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work!

Job Summary:

We are seeking a meticulous and experienced Quality Assurance (QA) Auditor to join our team. The QA Auditor is responsible for ensuring the integrity and accuracy of patient information within Health Information Technology (HIT) systems. The QA Auditor will navigate various health plan Electronic Medical Records (EMRs) to maintain high standards of quality assurance, and ensure compliance with industry standards and regulations.

Duties/Responsibilities:

• Identify, assess, correct, and monitor critical aspects of patient data while adhering to strict guidelines set by the Department of Health Care Services (DHCS) and Health Care Providers.
• Understand and apply practices and procedures established by DHCS and Providers.
• Navigate and work proficiently with multiple health plan EMR systems.
• Collaborate with various departments to ensure quality standards are met throughout the production process.
• Monitor and identify key errors within patient information.
• Prepare detailed audit reports and present findings to management.
• Comply with organizational guidelines and health care laws and regulations, including HIPAA.
• Perform other duties as assigned.

Education and Experience:

• High school diploma or GED required, Bachelor's in a related field preferred.
• Minimum of 1 year of experience in quality assurance auditing or a healthcare role required.

Required Skills/Abilities:

• Proficiency in Microsoft Office Suite and quality management software.
• Effective and professional communication skills, both written and verbal.
• Excellent analytical and problem-solving skills.
• Strong attention to detail and organizational skills.
• Bilingual in Spanish preferred.

Work Environment:

• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

Pay range

$18—$22 USD

Benefits

Our full-time employees are eligible for the following benefits enrollment after 60 days of employment:

Medical, Dental, & Vision Benefits: We have various insurance options for you and your family.

Short & Long-Term Disability Benefits: Protection when you need it most.

Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones.

Flexible Spending Accounts: Manage your finances with flexibility.

Employee Assistance Program (EAP): Support when life throws challenges your way.

401(K): Building your financial future with us. Effective after 1 year of employment.

Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.

Paid Holidays: Quality time to enjoy celebrations.

Employee Referral Program: Share the opportunities and reap the rewards.

Company Discount Program: Enjoy savings on everyday expenses and memberships.

Equal Employment Opportunity

Optima Medical Management Group and its divisions are an Equal Opportunity Employer. Optima MMG is committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state or local laws. Optima MMG is committed to providing reasonable accommodation for individuals with disabilities.

Pre-Employment

Optima Medical Management Group is a drug-free workplace. Employment is contingent upon a successful pre-employment drug screening and background check.