Director, Audits – Healthcare

🕒 Outubro 20

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $133.000 - $160.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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Health Services Advisory Group, Inc. (HSAG)

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 1979

🏥 Saúde

⚕️ Seguro de Saúde

🏛️ Governo

Healthcare • Healthcare Insurance • Government

A Health Services Advisory Group, Inc. (HSAG) é uma organização de melhoria da qualidade em saúde orientada por missão, que faz parceria com agências federais e estaduais, planos de saúde e prestadores para aprimorar a prestação de cuidados e os resultados dos pacientes. A HSAG oferece ciência de dados e análises avançadas, administração de pesquisas, revisão de prontuários médicos, auditorias e serviços de consultoria em saúde para apoiar programas de qualidade do Medicare e Medicaid, avaliações de isenções, iniciativas de saúde renal e pesquisas nacionais com pacientes. A organização foca em conformidade regulatória, medição de desempenho e melhoria da qualidade baseada em evidências para promover melhores resultados ao longo do continuum de cuidados em saúde.

Descrição

• Serve as the team leader on the PMV and HEDIS teams and senior leader within HSAG’s Medicaid Services division • Provide operational oversight of PMV and HEDIS audit activities • Act as a liaison between HSAG and state Medicaid agencies and organizations • Direct project planning, implementation, and performance monitoring across scope, staffing, schedules, budgets, and deliverables • Lead and coach auditors and assigned staff by setting expectations, monitoring performance, supporting development, and fostering accountability and collaboration • Ensure customer deliverables are accurate, high quality, internally reviewed and approved, and submitted on time • Leverage SharePoint and Copilot to streamline workflows and improve deliverable production • Monitor financial performance, including staffing plans, labor utilization, budgets, and forecasts • Identify and mitigate operational, contractual, staffing, and customer risks; escalate significant concerns to the Senior Executive Director • Participate in oversight of analytic output from partnering divisions • Develop and adhere to analytic project time and task schedules; identify process improvements and develop quality improvement activities • Conduct Internal Quality Control monitoring; present issues and recommended solutions and take corrective actions • Assist in contracting, including development and review of contract language, scopes of work, and budgeting • Define appropriate audit approaches • Present and communicate project results to nonanalytic staff members and customers • Lead responses to requests for proposals (RFPs) • Implement formal training series for junior and senior staff

🎯 Requisitos

• Bachelor’s degree or equivalent work experience in Medicaid managed care, HEDIS, performance measures, and/or audits • Credentialed as an NCQA Certified HEDIS Compliance Auditor (CHCA) or proficiency in HEDIS reporting • At least fifteen (15) years of work experience • At least ten (10) years of healthcare experience, preferably Medicaid • Budget and cost proposal development experience, including leading cost proposal development • Contract development and review experience • Expertise in Medicaid, health plan operations, or managed care • Expertise in evaluating medical and prescription drug claims and encounters; eligibility and enrollment; demographic; survey; and vital statistics data required • Experience evaluating electronic health record and clinical data preferred • Experience mentoring multiple staff • Demonstrated ability to supervise a team including responsibility for monitoring and evaluating performance • Excellent English/communication skills (i.e., spelling, composition, grammar, proofreading and editing) • Strong public speaking skills • Excellent interpersonal skills • Proficient in Microsoft Word, PowerPoint, Excel, Outlook and Copilot • Ability to lead several large projects simultaneously and lead multiple analytic teams working on disparate activities

🏖️ Benefícios

• A comfortable work-life balance, including flexible work schedules • Three weeks of paid time off • 13 company-paid holidays • Staff leave two hours early prior to each holiday • Medical insurance • Dental insurance • Vision insurance • Tuition reimbursement • 401(k) • Employee stock ownership plan

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