Senior Manager, Quality Audit Operations

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $120k - $160k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 1%

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Lead a team responsible for monitoring and continuously improving CCV’s systems and tools • Guide delivery of client services by planning, supporting, and/or managing post-implementation activities • Govern quality standards, criteria, monitoring processes, and the overall quality program framework • Establish and enforce data governance policies for audit findings, file layouts, and reporting artifacts • Identify early quality signals, operational exposure, and client-facing risks using root cause analysis, trend monitoring, and risk segmentation • Partner with operations, analytics, technology, training, and client-facing leaders to translate quality findings into action • Develop remediation plans with containment, ownership, timelines, measurable success criteria, governance checkpoints, and sustained-improvement evidence • Ensure AI-supported workflow changes use controlled pilots, release-readiness criteria, risk-based testing, documentation, post-implementation monitoring, and stakeholder alignment • Champion responsible AI innovation to improve processes and workflows • Plan quality data architecture, reporting processes, and enterprise-level organization with analytics, technology, and machine learning teams • Communicate emerging risks and remediation progress to senior leadership • Maintain relationships across the quality organization and audit enterprise • Identify and communicate opportunities to expand quality initiatives and create client value • Establish reporting and insights on quality program performance using meaningful metrics • Lead, motivate, recognize, mentor, and oversee team performance • Operationalize new quality programs and initiatives with internal stakeholders • Coordinate with CCV Operations and Validation, content, and Client Service teams • Support execution, monitoring, and maintenance of quality standards • Facilitate new concept development and maintenance of quality criteria within program tools • Manage external stakeholder expectations and understand project scope, schedules, resources, and operational cycles • Anticipate disconnects, identify solutions, follow projects through to results, and document improvements

🎯 Requirements

• Bachelor’s degree in a related field required • 3+ years of technical leadership experience involving people and projects • AI-native experience using generative AI applications such as Claude, Microsoft Copilot, or similar tools • Understanding of AI validation, exception review, quality drift, and human-in-the-loop controls • Experience influencing behavior and driving adoption of process, quality, or performance improvements across audit teams • Experience building remediation plans with clear owners, milestones, measurable success criteria, and follow-through • Ability to communicate complex quality and risk concerns concisely to leadership • Advanced knowledge of Excel, including Pivot Tables, macros, VLOOKUPs, queries, and advanced written formulas • Strong analytical and problem-solving ability • Experience in a HIPAA-regulated environment • Ability to speak in front of groups, with clients, and with physician executives • Ability to handle confidential information professionally • Ability to work independently and in a team environment • Ability to handle multiple tasks, prioritize, and meet deadlines • Ability to mentor staff and enhance performance • Skill in root cause analysis, trend monitoring, and risk segmentation • Technical aptitude to write/run SQL queries and interpret data flows • Experience managing data governance, data migration, or ETL processes is a plus • Experience with quality management methodologies such as Six Sigma, Lean, or CAPA is a plus • Experience developing or maintaining quality assurance programs, audit methodologies, or quality monitoring systems is a plus • Knowledge of medical reimbursement/payment policies, audit review methodologies, and medical terminology is a plus • Familiarity with Tableau, Power BI, or SQL for quality reporting and insights is a plus • Knowledge of AWS, Azure, or Google Cloud and modern data technologies is a plus • PMI/PMP certification is a plus • Must provide high-speed internet access/connectivity and office setup and maintenance • Must provide a dedicated, secure work area

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plan • Paid family leave • 9 paid holidays per year • 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service • High-speed internet access/connectivity and office setup and maintenance required for remote work • Dedicated, secure work area required for remote work