**Description** The Quality (Non-Calls) Professional 2 ensures that products meet certain standards of quality. The Quality (Non-Calls) Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. **Responsibilities** Hours for this position are Mon-Fri, 8am-5pm EST, with occasional overtime as necessary to meet the needs of the business. The Quality Audit Professional 2 audits quality of letter, keyed entries from billing and enrollment data. + Analyze Grievance/Appeals case information to ensure compliance of all CMS regulations and contractual guidelines. + Responsible for the review of written communication provided to members + Reviews case documentation to assess appropriate system entries have been thoroughly completed to mitigate risk associated with external audit reviews. + Responsible for driving accuracy and quality assurance, compliance to all established policies and procedures, and sound documentation for all activities. + Serve as a subject matter expert and make process recommendations. + Checks quality cases built by other associates to ensure highest level of quality. + Follows established guidelines/procedures. **Required Qualifications** + 2+ years of Grievance & Appeals/Auditing experience. + Must be bilingual English/Spanish with ability to speak read and write in both languages without limitations or assistance. + Excellent computer skills and ability to easily navigate multiple applications + Ability to work independently under general instructions and with a team **Preferred Qualifications** + Bachelor's Degree + Experience with Medicare and Medicaid **Work-At-Home Requirements** + Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. + A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. + Satellite and Wireless Internet service is NOT allowed for this role. + A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Scheduled Weekly Hours** 40 <>
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• Financial Services