Senior Manager – Quality Audit Operations

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $120k - $160k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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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 developing, executing, and continuously improving CCV quality assurance programs across multiple review types • Own and mature the quality program framework, including quality controls, sampling strategy, escalation routines, governance cadence, and sustained monitoring • Define, measure, and monitor accuracy, consistency, and decision quality across AI-supported and human-reviewed workflows • Identify early quality signals, accuracy drift, and client-facing or operational exposure 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 evidence of sustained improvement • 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 audit performance, review effectiveness, quality insights, accuracy, productivity, risk detection, and client value • Drive continuous improvement through accountability, disciplined execution, data-driven coaching, feedback loops, reinforcement, and outcome monitoring • Communicate emerging risks and remediation progress to senior leadership • Maintain relationships across the quality organization and audit enterprise; identify and communicate opportunities that create client value • Establish reporting and insights on quality program performance and business patterns using meaningful metrics • Ensure QA productivity goals and standards are met or exceeded; monitor coverage and redistribute work as needed • Remove productivity roadblocks and resolve performance issues • Lead, motivate, hire, develop, coach, and retain talent • Operationalize new quality programs and initiatives with internal stakeholders, including CCV Operations, Validiti, content teams, and Client Service • Coordinate execution, monitoring, and maintenance of quality standards with client service teams • Work with teams developing clinical, coding, and quality-related content • Oversee concept development and maintenance of quality criteria within program tools • Manage external stakeholder expectations, project scope, schedules, resources, operational cycles, and delivery impacts • Complete performance-review responsibilities, special projects, and assigned duties

🎯 Requirements

• Bachelor's degree in a related field required • 3+ years of technical leadership experience with 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 • Ability to translate AI quality concepts into measurable accuracy improvement • Experience influencing behavior and driving adoption of process, quality, or performance improvements across audit teams • Experience building remediation plans with owners, milestones, measurable success criteria, and follow-through • Ability to communicate complex quality and risk concerns concisely to senior leadership • Advanced Excel knowledge, including Pivot Tables, macros, VLOOKUPs, queries, and advanced formulas • Strong analytical and problem-solving ability • Organizational skills and attention to detail and accuracy • Ability and capacity to learn new concepts and software • Excellent written and verbal communication skills • Experience in a HIPAA-regulated environment • Comfortable speaking before groups, with clients, and with physician executives • Professional handling of confidential information • 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 • Skilled in root cause analysis, trend monitoring, and risk segmentation • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance • 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 • Must be able to perform duties with or without reasonable accommodation

🏖️ Benefits

• Discretionary bonus consideration • Medical insurance coverage • Dental insurance coverage • Vision insurance coverage • Disability insurance coverage • Life insurance coverage • 401(k) savings plans • 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 • Remote work arrangement • Dedicated secure work area and high-speed internet/home office setup supported as working requirements