Quality Audit Manager

Job Description

Quality Audit Manager

Group Manager I – BPM

Who We Are

UST HealthProof is a dynamic company with a mission to lower the cost of care and deliver the future of healthcare. Our consumer-centric approach gives our health plan customers a modern infrastructure and reduced administrative costs, helping to drive better business results for our customers — and better outcomes for our communities.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States. **

You Are**

UST HealthProof is looking for a motivated and collaborative Quality Audit Manager to oversee a team of 12-15 Quality Auditors. This role will report to the Director of Quality and Audit Operations. The primary objective of the Quality Audit Manager is to foster an environment of excellence in servicing Medicare Advantage Payor customers with UST HealthProof. This includes extensive interaction with customers organizations and multiple stakeholders, delivering a high-quality claims operation meeting, exceeding all service level agreements and KPIs, driving operational excellence and building competencies for delivery. **

The Opportunity**

• Directly managing a team of Quality Auditors and Sr. Quality Auditors
• Managing the quality audit programs for business operations across multiple health plan customers under various engagement models
• Ownership of the quality service level agreements (SLA) for each customer contract
• Developing, standardizing, and optimizing the quality audit programs across customers while keeping the integrity of the unique requirements of each customer
• Driving quality audit calibration and efficiency between the UST HealthProof quality audit teams and customer
• Designing a reporting mechanism to roll up each customer quality SLA score into a UST business operations quality metric
• Facilitating a review process for quality reports, trending, root cause analysis, and identifying opportunities for improvement
• Collaborate with business operations managers for each customer account and training to establish a plan of action for deficiencies identified and ensure corrective and preventive action
• Partner with the Director of Quality and Audit Operations in managing expenses and delivering profitability of quality audit function across customer engagements
• Coach and mentor direct reports for optimal performance including managing leave, training needs, feedback, and career planning

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. **

What You Need**

• 7 years of health plan administration experience required
• 3 years of management experience required
• Bachelors Degree required; Masters preferred
• Healthcare insurance domain (Medicare, Medicare Advantage, Medicaid, ACA, or Commercial) experience required
• Intermediate to advanced MS Excel and Powerpoint skills required
• Intermediate to advanced experience working with Reporting systems
• Intermediate to advanced experience working with claims processing systems
• Communication skills with peers, customers, and partners including the ability to convey information effectively
• Demonstrated forward thinking in areas of technology support, process improvement, and leadership.
• Effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.
• Demonstrate leadership ability and team-building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
• Ability to analyze contractual SLAs and KPIs and consistently meet critical deadlines
• Proven problem-solving skills and ability to translate knowledge to corporate departments.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by local law, UST Healthproof provides a reasonable range of compensation for roles that may be hired in California, Colorado, New York or Washington as set forth below. **

Role Location: Remote

Compensation Range:** $100,000-$130,000

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits. **

What We Believe**

We’re proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do. **

Humility**

We will listen, learn, be empathetic and help selflessly in our interactions with everyone. **

Humanity**

Through business, we will better the lives of those less fortunate than ourselves. **

Integrity**

We honor our commitments and act with responsibility in all our relationships. **

Equal Employment Opportunity Statement**

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

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