Quality Audit Specialist

POSITION SUMMARY/RESPONSIBILITIES

The Quality Audit Specialist is responsible for conducting independent audits and reviews to evaluate compliance with regulatory, contractual, accreditation, and organizational requirements across Community First Health Plans, Inc. (Community First). This role assesses documentation accuracy, process adherence, and operational effectiveness, identifies areas of risk and improvement, and supports organizational readiness efforts. The Quality Audit Specialist tracks and analyzes audit results, monitors trends, and collaborates with interdisciplinary leadership to develop and implement process improvements that enhance compliance, quality outcomes, and overall organizational performance while maintaining an objective and unbiased approach to all audit activities.

EDUCATION/EXPERIENCE

3-5 years of healthcare-related experience is required. College level course work preferred. Work experience in audits, utilization review, or quality assurance is preferred. Strong written and verbal communication skills. Proficient in using computer applications, including Microsoft Office (Word, Excel, PowerPoint). Excellent organizational and time management skills, with the ability to prioritize tasks effectively. Detail-oriented and able to maintain a high level of accuracy in work products. Knowledge of the criteria for Medicare, Medicaid, HMO, and private insurance coverage is highly preferred.

LICENSURE/CERTIFICATION

Certification in a health-related field preferred but not required.