TL QA Auditor

HealthFirst; United States; On-site; USD 80,000 - 120,000; Full time

Job summary

HealthFirst is seeking a Quality Audit Team Lead to manage daily QA activities and oversee internal audits of processes for employees and outsourced vendors. The role involves root-cause analysis, reporting, and collaboration with HR and business partners to improve quality and efficiency.

You will mentor a team, conduct training, and participate in quality calibration while upholding HealthFirst culture and compliance standards across locations.

Qualifications

• Minimum 1–2 years of Quality Assurance/Auditing experience.
• Strong claims knowledge and internal process knowledge preferred.
• Proficiency in MS Office applications (Excel, Word, PowerPoint).
• Experience with claims processing systems (preferably MHS).

Responsibilities

• Lead and develop a team of quality auditors, monitoring productivity and performance.
• Conduct regular 1x1 meetings to address team needs and barriers.
• Develop training materials and onboard/train new and existing staff.
• Collaborate with internal partners and vendors to drive quality improvements.

Skills

QA Auditing

Claims systems

MS Office

Data analysis

Communication

Education

Associate or Bachelor’s degree

Tools

Microsoft Excel

Microsoft Word

PowerPoint

MHS system

Job description

The Quality Audit (QA) Team Lead is responsible for managing the daily activities of the Quality Audit Team. The QA Team Lead is also responsible for performing internal quality audits of operational processes for internal employees and outsourced vendors to ensure compliance with policies, procedures, and quality standards. The incumbent will oversee the team, investigate, audit, and conduct root cause analysis. The individual at this level will embody Healthfirst’s Culture Drivers through their workplace behavior.

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.

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 [e-mail] 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 HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.

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

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

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, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.