TL QA Auditor

Healthfirst; Town of Florida (NY); Hybrid; USD 83,000 - 120,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Incentive programs

Life insurance

401k contributions

Job summary

Healthfirst in New York is seeking a Quality Audit Lead to manage a team of auditors, monitor inventory and productivity, and drive process improvements across the department. You will coach, onboard and develop staff, partner with internal teams and vendors, and prepare reports with actionable recommendations while supporting UAT and system enhancements.

This role requires strong communication, leadership, and a commitment to equal opportunity employment.

Qualifications

• High school diploma or GED is required.
• Experience in quality auditing (1-2 years) preferred.
• Proficient in MS Office: Excel, Word, PowerPoint.
• Experience with claims processing systems, preferably MHS.

Responsibilities

• Lead a team of quality auditors and monitor inventory and productivity.
• Conduct regular 1x1 meetings to address team needs.
• Develop and onboard training materials for new and existing staff.
• Collaborate with internal partners and vendors to improve audit processes.
• Participate in quality calibration sessions.
• Support HR on performance, staffing, and relations initiatives.
• Make critical decisions to support the department.
• Prepare reports documenting results and deliverables.
• Assist with UAT, system enhancements or projects with Business Operations.

Skills

Quality Assurance

Auditing

MS Office

Excel

Word

PowerPoint

MHS

Education

High school diploma or GED

Associate or Bachelor’s degree (preferred)

Tools

MHS

Job description

Responsibilities

• Manages a team of quality auditors, with the responsibility for monitoring inventory and productivity, coaching and providing feedback, performance management and other leadership responsibilities as assigned.
• Conducts regular 1x1 meetings to understand the team’s needs and barriers.
• Delivers Develops training materials for employees as needed and ensures new hires and existing are on-boarded and trained accordingly.
• Partners with internal business partners and vendors to discuss topics related to quality audit results, processes, and improvements to help drive consistency of the audit processes.
• Participates in /facilitates in quality calibration sessions.
• Partners with leadership and HR (as needed) on people initiatives including performance management, compensation planning, staffing, employee relations concerns/issues, and staffing.
• Makes critical decisions in support of the department as needed.
• Communicates effectively to hand-off and pick-up work from business partners and vendors.
• Identifies defects and improves departmental performance by supporting quality, operational efficiency and production goals.
• Assists in the development of departmental policies and procedures and reviews the efficiency of existing training.
• Meets established time frames and rates of performance for the quality and quantity of work for the position.
• Prepare reports to adequately document results, support department level and/or recommendations and ensure the timely delivery of reporting deliverables.
• Assist with performing User Acceptance Testing (UAT), system enhancements, or projects in partnership with Business Operations.
• Prepare reports to adequately document results, support department-level analysis and/or recommendations, and ensure the timely delivery of reporting deliverables.
• Other duties as assigned.

Minimum Qualifications

• High school diploma or GED
• Strong claims knowledge and internal process knowledge preferred.
• Quality Assurance/Auditing experience (1-2 years)
• Experience in Microsoft Office suite of applications including Excel (formatting formulas, managing data, and filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations)
• Proficiency in using Claims processing systems (preferably MHS)

Preferred Qualifications

• Associate or Bachelor’s degree from an accredited institution
• Experience in an audit capacity conducting audits and root cause analysis. (3-5 years)
• Experience in Performance Management and employee coaching.
• Proven ability to handle multiple assignments, projects, and deliverables.
• Knowledge of at least two or more lines of business such as Medicare NY/NJ, Medicaid, Family Health Plus, Child Health Plus, NH Family Experience handling confidential information.
• Strong time management and Interpersonal skills

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360 All Other Locations (within approved locations): $73,400 - $109,225

In addition to your salary, Healthfirst offers employees a full range of benefits such as

• medical, dental and vision coverage
• incentive and recognition programs
• life insurance
• 401k contributions (all benefits are subject to eligibility requirements)

Healthfirst is New York’s largest not-for-profit health insurer offering it’s nearly 1.7 million members access to high-quality, affordable healthcare. As part of the community for nearly 30 years, Healthfirst’s unique advantage is rooted in its belief that good health doesn’t start in a doctor’s office. The company’s mission is to put its members first by working closely with care providers and community leaders to address broader issues that can impact health and well-being. This value-based care model is the foundation of the company’s sustained growth in one of the most dynamic markets in the country. So, if you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people’s lives, then Healthfirst is for you.