Director, Audits – Healthcare

🔥 16 hours ago

🇺🇸 United States – Remote

💵 $133k - $160k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 0%

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Health Services Advisory Group, Inc. (HSAG)

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1979

🏥 Healthcare

⚕️ Healthcare Insurance

🏛️ Government

Healthcare • Healthcare Insurance • Government

Health Services Advisory Group, Inc. (HSAG) is a mission-driven healthcare quality improvement organization that partners with federal and state agencies, health plans, and providers to improve care delivery and patient outcomes. HSAG provides data science and advanced analytics, survey administration, medical record case review, audits, and healthcare consulting services to support Medicare and Medicaid quality programs, waiver evaluations, kidney health initiatives, and national patient surveys. The organization focuses on regulatory compliance, performance measurement, and evidence-based quality improvement to drive better outcomes across the healthcare continuum.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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