Sr. Health Plan Auditor

1 week ago

Phoenix, Arizona, United States Health Services Advisory Group Full time

Are you passionate about improving the quality of healthcare?

Are you ready to leverage your talents to make healthcare better for everyone?

Do you want the opportunity to give back to your community?

Do you want to have fun at work?

Then join the growing team at Health Services Advisory Group (HSAG) that is transforming the delivery of healthcare in the United States

Summary

HSAG is nationally recognized as an industry leader in the areas of audits, data analysis, measure development, and patient satisfaction surveys. We are in search of talented individuals who are interested in a career in healthcare performance measure auditing as an Auditor, Sr. in HSAG's Audits department within the Data Science & Advanced Analytics division. Together we can spread positive change to make healthcare better.

The Auditor, Sr. position benefits from HSAG's desire to grow its staff into future leaders of healthcare quality improvement in the nation. HSAG's auditors are provided formal training in an assortment of healthcare-related topics, including health policy, clinical concepts, overview of analytic methods, data sources, and management techniques.

HSAG offers :

  • A comfortable work-life balance, and flexible work schedules.
  • Three weeks of paid time off and 15 company-paid holidays where staff leave two hours early prior to each holiday to get a "jump start" on holiday festivities.
HSAG offers a competitive benefit package which includes medical, dental, vision, tuition reimbursement and 401(k).

The Auditor, Sr. is a primary contributor to the Audit department's work that spans the broad spectrum of healthcare performance measurement projects at HSAG. Driven by intellectual curiosity and a passion for healthcare quality, this position performs-under supervision-healthcare auditing, data validation, and performance measurement projects through various stages including implementation, day-to-day operations, audit support, evaluation, and reporting. Activities include independently developing work plans, report templates, and timelines; independently leading contracts and project tasks; guiding coordination and Auditor I, II, and III staff in oversight and maintenance of project files and other project tasks; leading client teleconferences and meetings; performing online research on healthcare topics; leading performance measure validation audits; and providing regular progress reports to Data Science & Advanced Analytics management staff.

Details regarding potential project assignments will be discussed with potential candidates during the interview process.

Essential Competencies, Duties and Responsibilities
  • Serve as a primary contributing member of HSAG's Audits department within DSAA.
  • Serve as a lead auditor for all performance measure validation audits.
  • Lead and manage multiple client contracts as primary point-of-contact and subject matter expert.
  • Mentor and train junior staff with limited supervision.
  • Provide oversight of supplemental Healthcare Effectiveness Data and Information Set (HEDIS)
    [1]
    audit operations.
  • Independently act in a liaison capacity between appropriate management personnel and staff, transmitting decisions and information to organizational units as appropriate, as well as outside agencies and organizations.
  • Lead project management tasks, including communication (written, phone, fax).
  • Communicate directly and manage project partners, consultants, subcontractors, and other entities on audit and performance measure validation-related projects.
  • Maintain, tag, and sort documents for assigned projects on appropriate SharePoint team sites and HSAG's corporate and federal networks following HSAG prescribed governance rules.
  • Prepare project deliverables and lead documentation and submission of deliverable using the appropriate mechanism (i.e., electronic, hard copy, direct data entry etc.).
  • Develop and adhere to project time and task schedules, identify opportunities to improve the project process, and develop quality improvement activities accordingly.
  • Meet agreed-upon deadlines in a timely fashion and independently and accurately prepare and type deliverables, reports, various project documents, letters, and other material.
  • Lead and complete the development of written and data-oriented reports in Microsoft Word and Excel.
  • Conduct research via the Internet including literature searches of clinical topics as assigned.
  • Participate in and lead pertinent healthcare educational and training presentations as required.
  • Conduct Internal Quality Control (IQC) monitoring regarding efficiency/effectiveness of activities conducted. Present issues and recommended solutions and take corrective actions as indicated.
  • Serve as a subject matter expert to HSAG staff and clients on HEDIS measures and non-HEDIS performance measures as applicable.
  • Represent HSAG in a professional manner at all times.
[1]
HEDIS Certified Measures is a registered trademark of the National Committee for Quality Assurance (NCQA).

Compensation: 101,000 to 125,000/annually DOE

Job Requirements:

Education and/or Experience
  • Master's degree in business, science, or healthcare-related field.
  • At least seven years of work experience in healthcare and a minimum of ten years of work experience are required.
  • Certified HEDIS Compliance Auditor (CHCA) required.
  • At least five years of auditing experience and four years of experience as a lead auditor; at least four years in HEDIS auditing and/or data validation, with at least one year as a lead are required.
  • Advanced knowledge of performance measures is required.
  • Experience writing client reports as a lead author and report designer is required.
  • Prior experience leading multiple medium and large projects or contracts is required.
  • Experience writing responses to requests for proposals is required.
  • At least two years of supervisory experience, including experience mentoring junior staff.
Other Qualifications
  • Proficient English/communication skills (i.e., public speaking, spelling, composition, grammar, proofreading and editing).
  • Proficient interpersonal skills.
  • Experience in Microsoft Word, PowerPoint, and Outlook.
  • Experience in Microsoft Excel.
  • Experience in conducting research via the Internet.
  • Ability to handle several projects simultaneously and work with multiple teams.
Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

HSAG All User Information Security Responsibilities

All workforce members, volunteers, contractors or third-party agents of HSAG, Inc. who are authorized to access information systems and/or associated company data on paper or in electronic format are responsible for the following:
  • Adhering to policies, procedures and guidelines pertaining to the protection of HSAG Company Data.
  • Reporting actual or suspected breaches or vulnerabilities in the confidentiality, integrity or availability of HSAG Data to your immediate supervisor/manager, Corporate Compliance or Information Technology/Security Personnel.
  • Reporting actual or suspected breaches or vulnerabilities in confidentiality, integrity or availability of Corporate Data, may be reported anonymously, via the NAVEX Global Compliance hotline at

    .
HSAG publishes various policies, guidelines and procedures related to the protection of Corporate Data and Information Systems. They can be found on the corporate SharePoint website. Information on requirements that may be unique to your business unit or a system you have access to can be found by talking to your supervisor/manager or designated system administrator.

Disclaimer

This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts or working conditions associated with the position. While this is intended to be an accurate reflection of the current position, management reserves the right to revise the position or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, workload, rush jobs requiring non-regular work hours, or technological developments).

HSAG is an EEO Employer of Veterans protected under Section 4212.

If you have special needs and require assistance completing our employment application process, please feel free to contact us.

EOE M/F/Vet/Disability

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