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Director, Audits (Healthcare)

1 hour, 32 minutes ago
Anywhere
Full-time
Executive
Operations Manager
Project and Program Management
Apply Now
Health Services Advisory Group

Health Services Advisory Group

HSAG is a quality improvement organization that enhances healthcare quality for Medicare and Medicaid beneficiaries through reviews and interventions.

Health Care Providers & Services
201-500
Founded 1979
View All Jobs 6

Description

  • Lead the PMV and HEDIS teams and provide senior leadership within the Medicaid Services division.
  • Oversee all PMV and HEDIS audit activities, including audit approach development and analytic output from partner divisions.
  • Direct project planning, implementation, performance monitoring, staffing, schedules, budgets, and deliverables.
  • Manage multiple large-scale audit projects through implementation, analysis, reporting, budgeting, and forecasting.
  • Serve as a liaison between HSAG, state Medicaid agencies, and other client organizations.
  • Lead client meetings and teleconferences, present healthcare topics, and communicate project results to clients and nonanalytic audiences.
  • Coach, mentor, supervise, and evaluate auditors and other staff while fostering accountability and collaboration.
  • Ensure deliverables are accurate, internally reviewed, high quality, and submitted on time.
  • Monitor financial performance, labor utilization, staffing plans, budgets, and forecasts with Finance and executive leadership.
  • Identify, mitigate, and escalate operational, contractual, staffing, and customer risks; lead RFP responses, contracting support, and staff training.

Requirements

  • Bachelor’s degree or equivalent experience in Medicaid managed care, HEDIS, performance measures, or audits.
  • At least 15 years of professional work experience, including at least 10 years in healthcare; Medicaid experience preferred.
  • NCQA Certified HEDIS Compliance Auditor (CHCA) credential or proficiency in HEDIS reporting.
  • Expertise in Medicaid, health plan operations, or managed care.
  • Experience evaluating medical and pharmacy claims and encounters, eligibility and enrollment, demographic, survey, and vital statistics data.
  • Experience with electronic health record and clinical data (preferred).
  • Experience developing budgets and cost proposals, including leading cost proposal development.
  • Experience developing and reviewing contracts, scopes of work, and budgets.
  • Demonstrated experience supervising, mentoring, monitoring, and evaluating multiple staff members.
  • Proficiency with Microsoft Word, PowerPoint, Excel, Outlook, Copilot, and SharePoint; strong communication, public speaking, and project leadership skills.

Benefits

  • Flexible work schedules that support work-life balance.
  • Three weeks of paid time off.
  • 13 company-paid holidays, with early departure before each holiday.
  • Medical, dental, and vision insurance.
  • Tuition reimbursement.
  • 401(k) plan.
  • Employee stock ownership plan.

Interested in this position?

Apply directly on the company website

Apply Now

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