TL QA Auditor

Responsibilities:

• Manages a team of quality auditors, with the responsibility for monitoring inventory and productivity, coaching and providing feedback, performance management and other leadership responsibilities as assigned.

• Conducts regular 1x1 meetings to understand the teams needs and barriers.

• Delivers Develops training materials for employees as needed and ensures new hires and existing are on-boarded and trained accordingly.

• Partners with internal business partners and vendors to discuss topics related to quality audit results, processes, and improvements to help drive consistency of the audit processes.

• Participates in /facilitates in quality calibration sessions.

• Partners with leadership and HR (as needed) on people initiatives including performance management, compensation planning, staffing, employee relations concerns/issues, and staffing.

• Makes critical decisions in support of the department as needed.

• Communicates effectively to hand-off and pick-up work from business partners and vendors.

• Identifies defects and improves departmental performance by supporting quality, operational efficiency and production goals.

• Assists in the development of departmental policies and procedures and reviews the efficiency of existing training.

• Meets established time frames and rates of performance for the quality and quantity of work for the position.

• Prepare reports to adequately document results, support department level and/or recommendations and ensure the timely delivery of reporting deliverables.

• Assist with performing User Acceptance Testing (UAT), system enhancements, or projects in partnership with Business Operations

• Prepare reports to adequately document results, support department-level analysis and/or recommendations, and ensure the timely delivery of reporting deliverables.

• Other duties as assigned

Minimum Qualifications:

• High school diploma or GED

• Strong claims knowledge and internal process knowledge preferred.

• Quality Assurance/Auditing experience (1-2 years)

• Experience in Microsoft Office suite of applications including Excel (formatting formulas, managing data, and filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations).

• Proficiency in using Claims processing systems (preferably MHS)

Preferred Qualifications:

• Associate or Bachelors degree from an accredited institution

• Experience in an audit capacity conducting audits and root cause analysis. (3-5 years)

• Experience in Performance Management and employee coaching.

• Proven ability to handle multiple assignments, projects, and deliverables.

• Knowledge of at least two or more lines of business such as Medicare NY/NJ, Medicaid, Family Health Plus, Child Health Plus, NH Family

• Experience handling confidential information.

• Strong time management and Interpersonal skills

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360

All Other Locations (within approved locations): $73,400 - $109,225

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.