Senior Provider Quality Auditor

VSP Vision
United States
Apr 06, 2026
Support leadership with the coordination, implementation, and oversight of all facets of the Quality Management Program. Facilitate medical record audits, research complaints related to potential quality issues, analyze quality trends, and maintain thorough documentation of quality audits and investigations. Apply knowledge of healthcare quality standards to objectively and systematically assess provider adherence to established quality objectives and goals. Promote a culture of quality, excellence, and continuous improvement. Effectively communicate with physicians and other healthcare staff to ensure accurate, complete, and timely medical record documentation is received for quality assurance reviews Complete quality assurance reviews according to established audit schedules and procedures Obtain and review patient medical records in preparation for audit review by physician leadership and clinical reviewers Partner with clinical reviewers to educate contracted doctors and ensure compliance with appropriate standards of care, including facilitating the implementation of corrective action plans, when necessary Actively participate in quality investigations and the development/implementation of corrective action plans Inform Quality Management leadership of concerns related to corrective action plans Maintain a working knowledge of current clinical guidelines that affect quality assurance reviews and investigations Analyze audit findings to identify trends in non-compliance and present results to leadership and the Quality Management Committee Work with contracted partners to investigate and effectively resolve found quality of care and quality of service issues within established timeframes Collaborate with clinical reviewers to identify quality of care concerns and communicate corrective action plans to contracted doctors Escalate significant, recurring, or systemic quality concerns for further review and interventions Support the effective operations of the Quality Management Committee by preparing and presenting accurate reports, quality improvement work plans, interrater studies, and maintaining meeting records to ensure compliance with organizational and regulatory standards Research, analyze, and resolve complex issues and escalations related to medical record reviews, member complaints and grievances, and quality of care issues Lead end-to-end preparation and facilitation of quality assurance activities for client, regulatory, and accreditation surveys, including research audit documentation, and support of corrective action plans Maintain proper documentation of records, reports, audit findings, and corrective action plans in a manner that will allow data to be categorized, tracked, trended for analytics, and audited by clients, regulatory, and accreditation agencies Interpret and monitor quality assurance metrics to identify compliance with established quality goals, standards, and benchmarks Develop, implement, and distribute quality management policies, procedures, documents, and training materials in accordance with company standards, quality agencies, state and federal laws and regulations, and governing optometric associations' guidelines Other duties as assigned to promote and maintain quality within the company Job Specifications Typically has the following skills or abilities: Bachelor's degree in Business Administration, Healthcare Administration, Public Health, or other quality management-related field, or equivalent experience Minimum of four (4) years of quality assurance experience Strong knowledge of provider relations, quality management systems, and quality improvement processes preferred Excellent written, verbal, and interpersonal communication skills Ability to handle sensitive information with the highest degree of integrity, discretion, and confidentiality Self-motivated with the ability to prioritize and complete multiple complex work assignments independently and across a fast-paced team environment Highly analytical, with a knack for identifying trends, drawing conclusions, and communicating results Ability to learn complex processes, medical terminology, application systems, and identify effective business solutions through research, audit, and analysis Commitment to continuous process improvement #LI-VISIONCARE Compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding VSP Vision benefits, please click here. Salary Ranges: $63,000.00 - $108,675.00 VSP Vision is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to age, gender, race, color, religion, sex, national origin, disability or protected veteran status. We maintain a drug-free workplace and perform pre-employment substance abuse testing. Unincorporated LA County Residents: Qualified Applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act, and any other similar laws. 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