Director, Audits – Healthcare

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the team leader for the PMV and HEDIS teams and serve as a senior leader within HSAG’s Medicaid Services division.

• Oversee the operational aspects of PMV and HEDIS audit activities.

• Function as a liaison between HSAG and state Medicaid agencies as well as organizations.

• Direct project planning, execution, and performance monitoring with respect to scope, staffing, schedules, budgets, and deliverables.

• Lead and mentor auditors and assigned personnel by establishing expectations, monitoring performance, supporting development, and promoting accountability and collaboration.

• Ensure that customer deliverables are precise, of high quality, internally reviewed, approved, and submitted punctually.

• Utilize SharePoint and Copilot to enhance workflows and improve the production of deliverables.

• Monitor financial performance, which includes staffing plans, labor utilization, budgets, and forecasts.

• Identify and mitigate operational, contractual, staffing, and customer risks, escalating significant issues to the Senior Executive Director.

• Engage in oversight of analytic output from partnering divisions.

• Develop and comply with analytic project timelines and task schedules; identify process enhancements and create quality improvement initiatives.

• Conduct Internal Quality Control monitoring; present issues along with recommended solutions and take corrective measures.

• Assist in contracting tasks, including the development and review of contract language, scopes of work, and budgeting.

• Define suitable audit methodologies.

• Present and convey project outcomes to non-analytic staff members and clients.

• Lead responses to requests for proposals (RFPs).

• Implement a formal training series for both junior and senior staff.

⛳️ Requirements

• A 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 possess proficiency in HEDIS reporting.

• A minimum of fifteen (15) years of professional experience.

• At least ten (10) years of healthcare experience, preferably in Medicaid.

• Experience in budget and cost proposal development, including leading the cost proposal process.

• Background in contract development and review.

• Expertise in Medicaid, health plan operations, or managed care.

• Proficient in evaluating medical and prescription drug claims and encounters; eligibility and enrollment; demographic; survey; and vital statistics data.

• Experience in assessing electronic health records and clinical data is preferred.

• Proven experience in mentoring multiple staff members.

• Demonstrated ability to supervise a team, including responsibilities for monitoring and evaluating performance.

• Exceptional English communication skills (spelling, composition, grammar, proofreading, and editing).

• Strong public speaking abilities.

• Excellent interpersonal skills.

• Proficient in Microsoft Word, PowerPoint, Excel, Outlook, and Copilot.

• Capability to manage several large projects simultaneously and lead multiple analytic teams working on diverse activities.

🏝️ Benefits

• A comfortable work-life balance, featuring flexible work schedules.

• Three weeks of paid time off.

• 13 company-paid holidays.

• Staff may leave two hours early before each holiday.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Tuition reimbursement program.

• 401(k) retirement plan.

• Employee stock ownership plan.