Remote Clinical Quality Auditor Jobs (NOW HIRING)

Company Description
WHO IS GUIDEHEALTH?
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.
As a growing and innovative organization, we operate with a high degree of agility. Employees are expected to adapt to evolving business needs, step in to support cross-functional initiatives, and contribute beyond traditional role boundaries when needed. This collaborative and flexible mindset is essential to our success. We encourage cross-training, ongoing development, and a commitment to learning across all areas of the business-ensuring we continue to grow and you continue to thrive as a high-performing, mission-driven team.
Join us as we put healthcare on a better path!!
Job Description
WHAT YOU'LL BE DOING

• Work in a fully remote environment and virtually engage with company and team in your daily work.
• Subject Matter Expert (SME) on entire scope of QI measures, services, customers and quality initiatives under various commercial and governmental payers.
• Conduct proactive patient outreach initiatives to identify and address quality gaps, engaging with patients to educate them on preventive care measures, schedule necessary screenings or appointments, and facilitate adherence to treatment plans, thereby contributing to improved health outcomes and closing quality gaps.
• Collect quality data using various methods of data sourcing-EMR, claims, provider outreach.
• Manage daily work using multiple systems and applications-EMR systems, payer portals, vendor platforms, Guidehealth applications, Microsoft 365 for Excel, Word and PowerPoint and Teams for messaging and meetings.
• Work with patient lists, gap lists, sourced health data and medical records in your daily work.
• Leverage all quality related resources to ensure accuracy and completeness of work measure/project instructions, NCQA/HEDIS® specifications, coding documents, quick reference guides.
• Prioritize daily work to meet various quality reporting deadlines and requirements.
• Communicate quality performances, barriers and improvement strategies both internally and with customers.
• Follow all established policies and procedures for various QI workflows to ensure overall success.
• Collaborate w/ customers, payers, co-workers to accomplish daily work.
• Participate in all departmental and payer sponsored webinars/trainings/support calls throughout the year.
• Communicate professionally and develop positive relationships with co-workers, customers, providers and providers' support staff.

Qualifications
WHAT YOU'LL NEED TO HAVE

• Associate degree or greater in related field or certified/licensed professional-CMA, LPN.
• Minimum 1-3 years of experience in healthcare setting; time spent working/charting/data abstraction via EMR system/s, knowledge of medical terminology, quality measures, medical billing/coding.
• Minimum 2 years' experience in Medicare Advantage Quality data abstraction and patient outreach
• Tech savvy in managing the technical side of this position-working with health data, working in excel and PowerPoint, navigating multiple systems and applications.
• Highly skilled in verbal and written communications.
• Strong attention to detail, organized and ability to meet hard deadlines.
• Ability to collaborate w/ others and work effectively with management, co-workers, and customers.

WOULD LOVE FOR YOU TO HAVE

• Knowledge or experience in quality improvement initiatives and data submissions required by various health insurance payers.
• Extensive experience with quality database entries and reporting.
• Experience in interpreting and reporting quality information, as well as training staff.
• Proficiency in Electronic Medical Record (EMR) software and cloud platforms.

Additional Information
The base pay range for this role is between $28-$30 per hour paid bi-weekly
ALIVE with Purpose: How We Thrive at Guidehealth
At Guidehealth, our values come to life in everything we do.

• We are Driven by Accountability - grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
• Always Growing, Always Learning - staying curious and continuously improving inspires us to shape a better future for healthcare.
• With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
• At Guidehealth, Every Voice Matters - we believe our collective strength is rooted in the unique perspectives of each team member.
• And through Empathy in Action, we build stronger connections with those who count on us.
• This is what it means to be ALIVE with purpose. This is how we thrive - together - at Guidehealth.

BENEFITS:
While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.
COMPENSATION:
The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.
OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT
Diversity, inclusion, and belonging are at the core of Guidehealth's values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.
OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA
This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth's custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.
As a remote-first organization handling sensitive healthcare data, Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy, data security, and compliance requirements.
REMOTE WORK TECHNICAL REQUIREMENTS
Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements.
SECONDARY EMPLOYMENT
At Guidehealth, we value transparency and collaboration as part of our commitment to excellence. As your primary employer, we kindly ask all team members to disclose any secondary employment, regardless of whether it may present a potential conflict of interest.
To ensure smooth teamwork and availability, employees must be accessible during our stated working hours. We foster connection and engagement by asking team members to join virtual meetings with their cameras on.
Videos To Watch
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