Claims Quality Auditor jobs in Portland, OR

Claims Quality Auditor audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Being a Claims Quality Auditor makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Additionally, Claims Quality Auditor typically reports to a supervisor or a manager. The Claims Quality Auditor gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Claims Quality Auditor typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Quality Assurance Auditor
  • Prestige Care
  • Vancouver, WA FULL_TIME
  • Calling all road warriors! This position is very travel heavy (at least 2 weeks of overnight travel a month) with the ability to work from home when not traveling.


    Full Wage Range: $85,000-$105,000 DOE and seniority with Prestige

    POSITION SUMMARY

    The Quality Assurance Auditor conducts routine mock surveys to assess regulatory compliance with federal, state, and local regulations and to ensure centers provide quality nursing care and services. Additionally, the Quality Assurance Auditor partners with the center and regional leadership to create plans of correction based on the mock survey results and monitors the center’s progress towards completing the plan. Provides additional support to sustain survey readiness as needed.


    ESSENTIAL DUTIES AND RESPONSIBILITIES

    • Participates as part of the mock survey team to conduct comprehensive audits of the skilled nursing center to assess survey preparedness. Conducts survey investigations through observations, record review, and interviewing residents, staff, and family members.
    • Evaluates and determines compliance with federal, state, and local regulations in areas such as environment, resident rights, abuse and neglect, dietary services, nursing services, social services, activities, infection control, and pharmaceutical services.
    • Coordinates a review of mock survey findings with center leadership. Reports on findings to appropriate regional and senior leadership including following up with Regional Director Operations and Regional Support Nurse; escalates to Chief Clinical Officer and Vice President of Compliance and Quality Assurance as need.
    • Partners with center leadership in the creation of a plan of correction upon completion of each mock survey. Provides support, instruction, and feedback to leadership as they develop the plan. Monitors center’s progress towards the completion of the plan of correction.
    • Conducts timely follow up reviews of the centers’ plan of correction to ensure areas identified have been corrected within established timeframes.
    • Supports the QAPI Specialist to ensure regional and center leadership are trained on the QAPI process and are engaged in ongoing process improvement to identify and correct possible regulatory and compliance issues and to ensure quality care and services are provided.
    • Completes a mock survey at each skilled nursing center at minimum of one time per year and twice per year for identified at-risk centers. May be responsible for creating and communicating the mock survey schedule.
    • Partners with the Regional Director of Operations and Regional Support Nurse to ensure survey preparedness of each center by identifying opportunities for improvement, problem solving to remove barriers, and making recommendations for additional support.
    • Participates in the continual process improvement review of the mock survey to ensure mock survey results accurately assess survey preparedness. Reviews state and federal survey results compared to mock survey findings and adjusts the mock survey process as needed.
    • Participates in regional and central support meetings to report on survey findings including attending the monthly Clinical Operations meeting.
    • Maintains professional knowledge of state, federal, and local regulations, and industry trends and best practices through continuing professional education, maintaining personal networks and participating in professional organizations.
    • Performs other duties as assigned.


    COMPANY WIDE RESPONSIBILITIES

    • Demonstrates Core Values of Respect, Integrity, Commitment, and Trust.
    • Supports a dignified and caring atmosphere with residents, residents’ families, visitors, and staff.
    • Protects privacy and confidentiality of information pertaining to residents, team members, the department/center/community, and company information and records.
    • Maintains a safe and secure working environment and practices safe working habits.


    QUALIFICATIONS AND EXPERIENCE

    • Minimum of 2 years of experience in skilled nursing. Solid knowledge of medical terminology and federal regulations related to long-term care facilities required.
    • Ability to exercise independent judgement and make sound decisions in the application of regulations.
    • Must be able to think critically, problem solve, and be a team player.
    • Strong organizational skills, attention to detail, and flexibility required.


    EDUCATION

    • Bachelor’s degree in social services, health administration, nursing, or equivalent knowledge and skills obtained through a combination of education, training, and experience.
    • A nursing degree will be considered in lieu of a bachelor’s degree.

    EOE/M/F/VETS/DISABLED – At Prestige, it is our promise to personally touch lives every day. It is a philosophy of caring based on our core values of integrity, trust, commitment, and respect, that are at the center of all that we do. We are committed to a diverse and inclusive workforce that represents all of us, coming from different experiences, cultures, backgrounds, and viewpoints. Inclusion is the way we treat one another and how we celebrate what makes us different.

    Prestige is proud to be an Equal Employment Opportunity employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

    Who is Prestige Care/Prestige Senior Living?

    Prestige Care is a family of over 75 skilled nursing post-acute care centers, as well as assisted living and memory care communities in 8 Western states. We are an organization of over 5,000 team members who serve thousands of residents, where we have the privilege of personally touching their lives every day.
    We have four core values of integrity, trust, commitment, and respect that guide everything that we do. With a strong commitment to career development and advancement, Prestige Care is a employer that can help you achieve your career goals and objectives. With a healthcare career at Prestige Care, you will enjoy a collaborative, team-oriented environment where your work truly matters at the end of every day.

    Summary of Benefits
    Full-time team members are eligible for Prestige’s comprehensive benefit package including choice of medical plans, HSA/FSA accounts, dental and vision insurance, and company paid life and AD&D insurance. All team members are eligible to participate in the company’s retirement plans with a company match for those who meet the hours and service requirements. Additional benefits include Employee Assistance Program and Education Reimbursement program.
    PTO:
    SNF/AL/PCI Salary: Accrue PTO at rate of 0.0615/hour during their first year/16 days.
    SNF/PCI Hourly: Full-time and Part-Time team members (over 20 hours/week) accrue PTO at rate of 0.0423/hour during their first year. 



  • 1 Month Ago

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Associate Coding Quality Auditor
  • Providence
  • Portland, OR OTHER
  • Description Associate Coding Quality Auditor \Remote - Most States Eligible The QI Coding Compliance Auditor and Trainer I is critical to the coding compliance program. Providence caregivers are not s...
  • 2 Months Ago

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Associate Coding Quality Auditor *Remote
  • Providence
  • Vancouver, WA OTHER
  • DescriptionAssociate Coding Quality Auditor - 100% Remote.Revenue Cycle is the name adopted to reflect the Providence employees who work throughout Providence Health & Services (PH&S) in revenue cycle...
  • 26 Days Ago

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PFS Coding Quality Auditor Educator
  • Women's Healthcare Associates, LLC
  • Portland, OR FULL_TIME
  • At WHA, we're a team, passionate about humanizing healthcare. We're inspired by the diverse stories, strength and resilience of our patients and the unique choices they make in pursuing health for the...
  • 2 Months Ago

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Associate Coding Quality Auditor *Remote, Most States Eligible
  • Providence Health
  • Vancouver, WA FULL_TIME
  • Description Associate Coding Quality Auditor - Remote, Most States Eligible. Revenue Cycle is the name adopted to reflect the Providence employees who work throughout Providence Health & Services (PH&...
  • 16 Days Ago

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0 Claims Quality Auditor jobs found in Portland, OR area

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Manufacturing Process Engineer
  • Zincfive Inc.
  • Tualatin, OR
  • The Manufacturing Process Engineer will be a key contributor to the quality organization and heavily influence the overa...
  • 4/26/2024 12:00:00 AM

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Associate Coding Quality Auditor *Remote, Most States Eligible*
  • Providence Health & Services
  • Vancouver, WA
  • Job Description Associate Coding Quality Auditor - Remote, Most States Eligible. Revenue Cycle is the name adopted to re...
  • 4/25/2024 12:00:00 AM

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Chemical Engineer Process Support Engineer
  • PMCS Group
  • Tualatin, OR
  • Job Description Job Description Minimum Qualifications: 3+ years’ experience with Semiconductor related process mechanic...
  • 4/25/2024 12:00:00 AM

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IS Data Quality Analyst
  • CareOregon
  • Portland, OR
  • Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, o...
  • 4/25/2024 12:00:00 AM

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Manufacturing Quality Engineer
  • ZincFive, Inc.
  • Tualatin, OR
  • The Manufacturing Quality Engineer will be a key contributor to the quality organization and heavily influence the overa...
  • 4/24/2024 12:00:00 AM

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Manufacturing Process Engineer
  • ZincFive, Inc.
  • Tualatin, OR
  • The Manufacturing Process Engineer will be a key contributor to the quality organization and heavily influence the overa...
  • 4/23/2024 12:00:00 AM

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Manufacturing Quality Engineer
  • Zincfive Inc.
  • Tualatin, OR
  • The Manufacturing Quality Engineer will be a key contributor to the quality organization and heavily influence the overa...
  • 4/23/2024 12:00:00 AM

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Quality Assurance Coordinator
  • Calibre Scientific
  • Vancouver, WA
  • Position Summary: To ensure compliance through the development, implementation, and maintenance of the Business Unit’s Q...
  • 4/22/2024 12:00:00 AM

Portland is the largest and most populous city in the U.S. state of Oregon and the seat of Multnomah County. It is a major port in the Willamette Valley region of the Pacific Northwest, at the confluence of the Willamette and Columbia rivers. As of 2017, Portland had an estimated population of 647,805, making it the 26th-largest city in the United States, and the second-most populous in the Pacific Northwest (after Seattle). Approximately 2.4 million people live in the Portland metropolitan statistical area (MSA), making it the 25th most populous MSA in the United States. Its Combined Statist...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Quality Auditor jobs
$47,910 to $58,723
Portland, Oregon area prices
were up 3.9% from a year ago

Claims Quality Auditor in Bloomington, IN
Evaluates claims activities of other departments and / or companies.
December 05, 2019