Quality Review Specialist | Remote | Contract to Hire

Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!

Walker Healthforce is seeking a Quality Review Specialist with 5 years’ experience to support a healthcare client. This is a 5-month contract to hire opportunity. START DATE: 12/15/2025 HOURS/SCHEDULE: Monday-Friday, 40 hours; mandatory to work holidays (rotating scheduled 3-4 holidays per year) and one weekend every 3rd weekend once training has been completed WORKER TYPE: W2

Work closely with Full-service Unit (FSU), Provider Telecommunication Center (PTC), and Medical Management Department (MMD) to ensure appeal process meets established guidelines. Adhere to accreditation and regulatory requirements to improve customer service and achieve organizational goals related to complaint and appeal resolution. Manage individual inventory through appropriate workflow. Facilitate final resolution of member and provider appeals. Participate in department initiatives related to NCQA and URAC audits, DOI audits, revision project, audits, and correspondence revision projects. Serve on workgroups. Adhere to compliance with external regulatory and accreditation standards. Facilitate access to appeal files by members or member designee under federal guidelines. Provide data for required reporting. Work directly with members and providers to resolve appeals. Support other team members in appeal resolution and in fulfilling other department responsibilities. Assist in maintaining working relationships across organizational lines. Ensure our members/providers requirements are always met. Communicate and interact effectively and professionally with co-workers, management, customers, etc. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies. Maintain complete confidentiality of company business. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.