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Appeals Quality Assurance Specialist in Latham, NY at Beacon Health Options

Date Posted: 5/22/2019

Job Snapshot

Job Description

About the Position

Beacon Health Options is currently seeking a dynamic Quality Assurance Specialist II to join our National Denials and Appeals team in Latham, NY or Cypress, CA!  The QA Specialist II will be responsible for leadership and coordination of quality review of denial and appeal notifications and system documentation. The incumbent will support department initiatives while ensuring completion in accordance with state, contract, Beacon Health Options, URAC and NCQA requirements.

*This position is on the late shift from 11:30am – 8:00pm*

Position Responsibilities

  • Monitor and evaluate clinical appeal documentation created by frontline staff. This includes reviewing, researching and investigating all types of clinical appeals and communicating with appropriate personnel to provide feedback and analyze everyday work functions.
  • Monitor and evaluate clinical appeal audits (internal QA) completed for frontline staff. This includes reviewing, researching and investigating all types of clinical appeals as well as the feedback given to the frontline staff in regards to their feedback on every day work functions.
  • Generate ideas for performance improvement, increasing member satisfaction, improving internal policies and procedures through monitoring of the front line staff as well as the clinical appeal auditors (internal QA).
  • Generate and conduct training opportunities (with frontline staff and internal QA) to improve the overall clinical appeal process.
  • Investigate non-standard requests and problems to provide assistance to frontline staff and internal QA.
  • Prepare, analyze, and submit numerous monthly, quarterly, and annual Quality Reports.   
  • Coordinate contract compliance audits to include developing audit tools, incorporating state corrective actions, participating in onsite audits, compiling audit results, preparing follow up letters with results and identified corrective actions, tracking submission of corrective actions, and summarizing overall results. 
  • Collaborate with Directors and Business Analysts to develop quality management measures including: Gathering data requirements, Analyzing and verifying data, preparing final reports, and Presenting findings to Teams, Committees and Governing Board, as needed.
  • Assist Directors in executing Quality Program by: Developing and presenting training materials, Generating committee agendas, Guiding focus groups, and Facilitating Project Team and Committee meetings
  • Conduct other routine Department tasks, including, but not limited to: Ensuring Assigned areas of responsibility are in compliance with contract, state, URAC and NCQA requirements, Coordinating with multiple departments and preparing documents for External Quality Review, URAC and NCQA Site Visits, Coordinating data collection for assigned quality activities and studies, and Completing annual updates of quality policies/procedures.
  • Occasional travel to offsite meetings may be required. 

Position Requirements:

  • Education: Bachelor’s Degree required
  • Relevant Work Experience: 2years of experience in quality assurance, quality management, managed care and/or healthcare required
  • Knowledge, Skills & Abilities:
    • Experience with Microsoft Word, Excel, and Outlook
    • Ability to work cooperatively with various departments/personnel within the company
    • Ability to identify pertinent data needed to resolve ongoing need for process improvement
    • Ability to make important decisions and provide results in a complex environment

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email ( Only candidates who have applied for an open position through our Careers page ( will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.