[Remote] Director, Audits (Healthcare)

Note: The job is a remote job and is open to candidates in USA. Health Services Advisory Group (HSAG) is hiring a Director, Audits to lead healthcare audit projects in its Medicaid Services division. The role oversees PMV and HEDIS audit operations, manages teams and project performance, and supports client relationships, quality control, and proposal development.

Responsibilities

• Serve as the team leader on the PMV and HEDIS teams and senior leader within HSAG’s Medicaid Services division
• Provide operational oversight of PMV and HEDIS audit activities as a leader on the HSAG Audits Team
• Act in a liaison capacity between HSAG and state Medicaid agencies and organizations
• Direct project planning, implementation, and performance monitoring across scope, staffing, schedules, budgets, and deliverables for the Audits department
• Lead and coach auditors and other assigned staff by setting expectations, monitoring performance, supporting development, and fostering accountability and collaboration
• Ensure customer deliverables are accurate, high quality, internally reviewed and approved, and submitted on time
• Leverage tools such as SharePoint and Copilot to streamline workflows and improve deliverable production
• Monitor financial performance, including staffing plans, labor utilization, budgets, and forecasts, in coordination with Finance and executive leadership
• Identify and mitigate operational, contractual, staffing, and customer risks; escalate significant concerns to the Senior Executive Director
• Participate in the oversight of analytic output from partnering divisions
• Develop and adhere to analytic project time and task schedules, identify opportunities to improve the project process, and develop quality improvement activities accordingly
• Conduct Internal Quality Control (IQC) monitoring regarding efficiency/effectiveness of activities conducted. Present issues and recommended solutions and take corrective actions as indicated
• Assist in the contracting process, including the development and review of contract language, scopes of work, and budgeting
• Define appropriate audit approaches
• Present and communicate project results to nonanalytic staff members and customers
• Represent HSAG in a professional manner at all times

Skills

• Bachelor's degree or equivalent work experience in the area of Medicaid managed care, HEDIS, performance measures, and/or audits
• Credentialed as an NCQA Certified HEDIS Compliance Auditor (CHCA) or proficiency in HEDIS reporting
• At least fifteen (15) years of work experience
• At least ten (10) years of healthcare experience
• Budget and cost proposal development experience, including leading cost proposal development
• Contract development and review experience
• Expertise in Medicaid, health plan operations, or managed care
• Expertise in evaluating medical and prescription drug claims and encounters; eligibility and enrollment; demographic; survey; and vital statistics data required
• Experience mentoring multiple staff
• Demonstrated ability to supervise a team including responsibility for monitoring and evaluating performance
• Excellent English/communication skills (i.e., spelling, composition, grammar, proofreading and editing)
• Strong public speaking skills
• Excellent interpersonal skills
• Proficient in Microsoft Word, PowerPoint, Excel, Outlook and Copilot
• Ability to lead several large projects simultaneously and lead multiple analytic teams working on disparate activities
• At least ten (10) years of healthcare experience, preferably Medicaid
• Experience evaluating electronic health record and clinical data preferred

Benefits

• Flexible work schedules.
• Three weeks of paid time off.
• 13 company-paid holidays, with staff leaving two hours early prior to each holiday.
• Medical, dental, and vision benefits.
• Tuition reimbursement.
• 401(k).
• Employee stock ownership plan.

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