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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in quality assurance processes, ensuring compliance with federal regulations and internal standards while maintaining confidentiality of Protected Health Information (PHI) and Personally Identifiable Information (PII). Proficient in document review, editing, and communication, with a strong focus on detail and organization to meet client expectations.
Highest-signal resume keywords
Quality AssuranceHIPAA ComplianceDocument ReviewMicrosoft Office SuiteHealthcare Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality Assurance ChecksDocument Review SkillsEditing SkillsRegulatory KnowledgeDetail-Oriented Focus
Soft Skills
Strong Communication SkillsOrganizational SkillsAbility to Prioritize Workload
Tools & Technologies
Microsoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft Access
Industry Keywords
MedicareMedicaidProtected Health InformationPersonally Identifiable InformationFederal Regulations
About the role
Key responsibilities & impact- Perform quality assurance checks on Medicare and Medicaid investigation and audit file documentation
- Ensure information adequacy and product quality meets or exceeds client expectations
- Ensure documents comply with federal regulations and internal quality control practices
- Work closely with investigators and administrative action personnel to provide complete, quality products
- Complete document requests timely and efficiently, independently and as part of a team
- Prioritize multiple document types and requests daily
- Verify Protective Health Information (PHI) and Personally Identifiable Information (PII)
- Review document content and communicate with requestors regarding questions or required rework
- Handle priority requests according to CMS guidelines and metrics
- Maintain confidentiality and comply with health privacy laws, rules, and regulations
- Report workload status and activity
- Review document creation and revisions and verify correct versions before distribution
- Approve finished products, return documents for rework, and confirm rework
- Document review results through reports and logs
- Participate in and support internal and external audits
- Update job knowledge through educational opportunities
Requirements
What you’ll need- 2 years with BS/BA; 0 years with MS/MA; 6 years with a HS Diploma/equivalent
- Proficient in editing and review skills
- Knowledge of applicable regulatory and industry standards, including HIPAA and content review
- Proficient with reviews requiring extremely detail-oriented focus
- Strong communication, written and oral skills
- Strong organization skills and ability to prioritize workload appropriately
- Proficient in Microsoft Word, Excel, PowerPoint, Access
- US Citizenship Required
- Healthcare experience preferred
- Medicaid/Medicare experience preferred
Benefits
Comp & perks- Telework available from any state in US
- Employees may be eligible for overtime
- Employees may be eligible for shift differential
- Employees may be eligible for a discretionary bonus
