Quality Assurance Auditor – Government Programs

About the role

Moda is seeking a full‑time Quality Assurance Auditor to ensure compliance with state and federal regulations for Medicare and Medicaid appeals and grievances. This remote position focuses on pre‑closure audits, performance tracking, and continuous process improvement within the Government Programs division.

Key responsibilities

• Conduct pre‑closure audits of appeal and grievance cases to verify accuracy and completeness.
• Monitor and maintain compliance with CMS Medicare and Medicaid rules.
• Track departmental performance metrics and generate accurate reports.
• Support staff training initiatives and drive continuous improvement efforts.
• Ensure that appeal procedures are followed and that outcomes are documented correctly.
• Provide occasional overtime coverage, including weekends and holidays, as needed.

Required profile

• High school diploma or equivalent.
• Minimum 2 years experience as an Appeal Coordinator or in a related role.
• Advanced knowledge of benefit plans, Moda Health policies, and CMS regulations.
• Strong written and verbal communication, analytical, problem‑solving, and organizational abilities.
• Ability to work under pressure, meet tight deadlines, and maintain confidentiality.

Required skills

• Proficiency with Microsoft Word.
• Proficiency with Microsoft Excel.

What we offer

• Medical, dental, vision, pharmacy, life and disability insurance.
• 401(k) matching and Flexible Spending Account.
• Employee Assistance Program.
• PTO and company‑paid holidays.