Senior Manager, Quality Assurance, Compliance
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Job Description
Senior Manager of Quality Assurance and Compliance overseeing quality and compliance at SCAN, a nonprofit health organization serving older adults in the US.
Responsibilities:
- Responsible for developing and implementing a quality assurance program, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes.
- Partner with Ops leadership to design and develop an effective Quality Assurance and Compliance program gaining alignment on methodology, audit approach, KPIs, standards and issue resolution process
- Manage quality and Compliance reporting.
- Coordinate accurate and timely submission of data, including audit readiness and documentation standards for Operations
- Collaborate with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfaction.
- Monitor and communicate performance trends track and analyze key performance indicators (KPIs).
- Share actionable insights and recommendations with senior leadership to inform strategic planning and resource allocation.
- Establish effective governance framework to include Audit the Auditor mechanism to achieve organizational goals related to quality and compliance.
- Lead a team of quality assurance and compliance professionals mentoring, fostering positive team culture, promote leadership growth, encourage innovation, and continuous learning to achieve team or individual goals
- Identifying trend and areas of opportunity for process improvements and additional training
- Work closely with operations leadership to review finding, develop action plans and remediate issues
- Partner with operational leadership to review finding, develop corrective action plans, and remediate identified issues to the root cause ensuring a closed loop process
- Monitor industry trends, regulatory changes and current events to ensure team remains informed and adapts to evolving policies and procedures.
- Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
- Actively support the achievement of SCAN’s Vision and Goals.
Requirements:
- Bachelor’s Degree required
- Graduate or Advanced Degree or equivalent experience preferred
- Audit Certification preferred
- 5 years of related experience QA and compliance operations experience with Medicare and Medicaid
- 3+ years’ management experience in healthcare environment, preferably Medicare Advantage
- 8+ years of progressive experience in healthcare operations
- Experience managing Quality Assurance and/or Operations audit team
- Experience working with AI or other machine learning tools to assist with streamlining QA processes
- Deep experience in operational areas such as claims, configuration, provider data, benefits, enrollment, appeals and grievances
- Proven success leading quality and compliance in a matrixed environment
- Strong working knowledge of CMS and state regulations and operational implications
- Leadership - Skilled to develops others
- Problem Solving - Make critical decisions, often involving high-level risk assessment and the ability to adapt to changing circumstances
- Strategic Mindset - Formulates strategy and maps steps to achieve strategic goals
- Business Insight - In-Depth understanding of the business
- Oral and written communication skills
- Problem management
- Judgement
- Detail oriented
- Interpersonal skills
- Strong analytical and critical thinking skills
- Detail oriented, organized and strong time management skills.
Benefits:
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
- Excellent 401(k) Retirement Saving Plan with employer match and contribution
- Robust employee recognition program
- Tuition reimbursement
- An opportunity to become part of a team that makes a difference to our members and our community every day!
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