Quality Auditor

TMF Health Quality Institute focuses on promoting quality health care through contracts with federal, state and local governments, as well as private organizations. For over 40 years, TMF has helped health care providers and practitioners in a variety of settings improve care for their patients. TMF was chartered in 1971 as a private, nonprofit organization of licensed physicians (MDs and DOs) to lead quality improvement and medical review efforts in Texas. Originally known as the Texas Medical Foundation, the company changed its name to TMF Health Quality Institute in 2005 to reflect the expansion of its work throughout the nation.

**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.** *This position is located Remote United States* Position Purpose: Audits second level appeals of claims to ensure compliance with contract requirements and performs user testing and interface with the required systems. Benefits: C2C offers an excellent benefits package, including: Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance Section 125 plan 401K Competitive salary License/credentials reimbursement Tuition Reimbursement

Performs audits and examinations of case files to identify inaccuracies and non-compliance issues. Shares educational feedback, trends and insight individually and collectively with the staff. Performs data analysis to identify improvement opportunities in the appeals process and reduce unnecessary appeals. Provides quality and analytical support to the department including assisting senior analyst in data interpretation and preliminary analysis. Prepares training materials and provides technical training to employees.