Manager Compliance & Quality Assurance

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health. Manager Compliance & Quality Assurance oversees the Quality Assurance function for all our business lines. The individual will lead a team of Quality Assurance supervisors and audit professionals to continuously enhance and execute quality programs. The role entails assisting the business's strategic goals and the wider corporate quality assurance, internal and external audit, and compliance requirements. Job Description: •Responsible for managing all quality operational activities related to claims and enrollment transactions. This includes ensuring accurate and timely identification of issues, documentation of audit findings, analysis of audit results, and communication of results to the operations teams and Compliance. •Accountable for all operational transaction auditing associated with regulatory compliance audits and client Performance Guarantees (PGs) reporting. •Actively manages daily production activities of quality analysts to ensure both production and accuracy of audits are maintained at set standards •Meets regularly with internal business partners to assist in problem solving, providing root cause analyses, and maintains the operational voice to reinforce good quality performance, while immediately raising and solution for bad quality performance. •Support internal, external customer, third-party, state, and federal audits by providing data, validating reports, and submitting required files in accordance with guidelines and specifications. •Provide operational performance metrics and additional trend analysis to monitor operational metrics on daily, weekly, and monthly basis. •Actively manages professional development of direct reports and provides motivation, recognition, and leadership through coaching, counseling, and performance appraisals. Qualifications •BA/BS in Information Systems, Computer Science, Business Administration, Data Analytics, or related field or equivalent experience. •Eight (8) or more years of related experience leading operational quality assurance, healthcare compliance and/or business systems analysis experience in healthcare operations. •Strong understanding of quality assurance standards, plan development, change control, and documentation •Preferred experience in insurance claims handling and administration •Very strong analytical and technical skills in using data analytics to investigate root causes for deficiencies and effectiveness of controls •Ability to manage multiple projects in a dynamic development environment •Excellent verbal and written communications skills. Hybrid Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

Created: 2024-11-05