Operational Quality Assurance Lead
1 week ago
We are seeking an experienced Operational Quality Assurance Lead to join our team at Health First. This is a full-time opportunity that offers a competitive salary and benefits package.
About the RoleThe Operational Quality Assurance Lead will be responsible for designing and executing the operations internal audit strategy to assess financial, operational, and compliance risks. This includes leading a team responsible for performing a variety of operational audit functions across business teams, identifying new and innovative methodologies, and developing talent to meet departmental objectives.
The ideal candidate will have experience with regulatory standards and internal policies, as well as the ability to lead, coordinate, and actively participate in managing audit planning, conducting audits, preparing audit evidence, assessing the quality of audit evidence, and ensuring audit readiness for Operations audits.
This role requires strong facilitation, consulting, and influence skills across a variety of audiences, with exceptional verbal and written communications and content. The successful candidate will also have proven ability to manage and collaborate with senior stakeholders and across operations teams.
Key Responsibilities- Design and execute the operations internal audit strategy to assess financial, operational, and compliance risks
- Lead a team responsible for performing a variety of operational audit functions across business teams
- Develop and implement quality assurance frameworks and standards across various operations
- Oversee quality assessments to ensure that customer service, claims processing, and other critical functions meet defined quality benchmarks
- Analyze data from quality assessments to identify trends, areas of improvement, and training needs
- Work with departments to establish performance metrics and monitor adherence to quality standards
- Ensure compliance with healthcare regulations and industry standards, addressing changes in regulatory requirements
- Bachelor's degree from an accredited institution or relevant experience
- HS Diploma or GED from accredited institution
- Work experience requiring knowledge of an array of NYS and federal rules and guidelines that impact Contact Center Operations, Enrollment and Billing and Claims operations for Medicaid, Medicare, and Commercial lines of business
- Work experience requiring knowledge of Medicaid and Medicare
- Previous management and oversight experience of regulatory and compliance initiatives
- Substantial experience leading complex, operations-wide initiatives and the development and implementation of impactful audits and root cause analysis
- Science and research-based knowledge in a variety of topics related to operational audits
- Project management experience
- Power BI Microsoft software tool
$110,000 - $140,000 per year, depending on experience.
What We OfferAt Health First, we offer a competitive salary and benefits package, including health insurance, retirement savings plan, and paid time off. We are an equal opportunity employer and welcome applications from diverse candidates.
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