The QA Audit Manager oversees quality monitoring functions and is responsible for assuring that standards are being evaluated fairly and consistently in compliance with policies, procedures, and quality standards in all Healthfirst Operations processes and supporting systems as well as conduct compliance and operational audits to identify areas of risk and make recommendations to help improve operational efficiency and effectiveness. The QA Manager demonstrates understanding and applicability of different Quality Management methodologies and Problem-Tracking & Feedback Loop while also building constructive relationships with Operations process owners.
Duties and Responsibilities
- Evaluate the design and effectiveness of controls to manage risk within our risk appetite and tolerance leveraging standard industry practices to include the preparation and delivery of formal communications expressing opinions and providing insight on the adequacy and effectiveness of business processes and controls
- Support cross functional risk assessment activities to identify, assess and address key risks across various operational areas and to prepare the internal audit plan
- Supervise and control the full audit cycle including risk management and control management over operations’ effectiveness, financial reliability and compliance with all applicable directives and regulations
- Independently create professional reports & dashboards, manage meetings/schedules, root cause and review issues, collaborate with leaders, facilitate discussions to align on corrective actions, and follow up with Management to ensure actions are taken timely as agreed
- Responsible for overall development and execution of process reviews/audits which includes identifying scope, developing audit programs, mapping processes, reviewing work papers, finalizing audit reports, as well as obtaining and monitoring management action plans
- Provide recommendations and participate/lead initiatives to enhance the audit processes
- Develop recommendations that are actionable and agreed to by management and follow-up to ensure appropriate completion
- Plan, coordinate and execute core assurance and business assessment activities
- Supervise and assist a team of auditors to ensure completion of audit activities of various groups for compliance with key controls compliance with plans, policies, procedures, regulatory requirements, and best practices.
- Ensure productivity & accuracy of a team of auditors to meet or exceed department standards.
- Supervise team to ensure time and attendance are properly managed and over time targets are achieved.
- Supervise, coach, evaluate and develop individuals on a variety of work-related issues toward the continual improvement and overall management of performance within the department.
- Maintain open communication and a strong network with management and business leaders regarding QA assessments, findings and recommended improvements that are independently derived through applying QA & Audit standards.
- Manage call monitoring of incoming and/or outgoing calls to confirm standards are met, ID performance gaps, and analyze errors to determine root causes
- Assess, evaluate, and promote compliance to internal policies
- Stay abreast of best practices both internally and externally and provide a conduit for introducing those practices to the organization
- Develop and deliver training on various audit and process improvement topics
- Support strategic business initiatives to continuously improve internal processes that optimize internal controls and reduce total cost of controls
- Support external auditors as assigned
- Perform special projects as needed
- Other duties as assigned
- Knowledge of accepted principles and practices of auditing, following written audit programs, and preparing adequate working papers to document audit work performed and conclusions reached.
- Experience with process mapping, risk assessment, and audit tools.
- Must demonstrate ability to understand and implement internal control concepts and perform root cause analysis to solve complex problems.
- Demonstrated experience leading a team of QA auditors or an operational team and maintain positive morale as well as break down barriers to success.
- Technical and data management skills including ability to identify, obtain, format, model, manipulate, and analyze large amounts of data and compile detailed reports / dashboards.
- Advanced computer skills on MS Office (i.e., Excel, Word, PowerPoint). Skilled in creating documents, V-lookups and pivot tables within Microsoft Excel
- High ethical standards and values with ability to handle confidential/sensitive issues and information with the highest degree of professional responsibility.
- Must exercise accuracy, discretion, good judgment, strong attention to detail, courtesy, tact, and patience.
- Ability to effectively plan, organize, prioritize, and complete work assignments/projects.
- Ability to communicate effectively, both orally and in writing, with peers, managers, and the public, on both individual and group levels.
- Ability to work independently and meet multiple deadlines.
- Bachelor's degree from an accredited institution or equivalent work experience
- Familiarity with GAAP, COSO, SOX and other audit principles preferred
- Experience with data analytic software (SQL, ACL, Alteryx, Tableau)Knowledge of at least two or more lines of business such as Medicare NY, Medicaid, Child Health Plus, QHP, EP, HARP
- Bachelor's degree in Accounting, Finance, or Business Administration from an accredited institution preferred
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement