Director, Audits (Healthcare)

Are you passionate about improving the quality of healthcare?

Are you ready to leverage your talents to make healthcare better for everyone?

Do you want the opportunity to give back to your community?

Do you want to have fun at work ?

Then join the growing team at Health Services Advisory Group (HSAG) that is transforming the delivery of healthcare in the United States!

SUMMARY

HSAG is nationally recognized as an industry leader in the areas of healthcare audits, data analysis, measure development, and survey research. We are in search of talented individuals who are interested in a leadership position healthcare analytics and data science as a Director, Audits in HSAG’s Medicaid Services division. Together we can spread positive change to make healthcare better.

UNIQUE BENEFITS

The Director, Audits position benefits from HSAG’s desire to grow its staff into future leaders of healthcare quality improvement in the nation. The Director provides leadership within the Medicaid Services division across the entire array of healthcare audit projects. The Director, Audits position will supervise the Performance Measure Validation (PMV) and Healthcare Effectiveness Data and Information Set (HEDIS ® [1] ) staff in the Audits department.

HSAG offers :

• A comfortable work-life balance, including flexible work schedules.
• Three weeks of paid time off and 13 company-paid holidays where staff leave two hours early prior to each holiday to get a “jump start” on holiday festivities.

HSAG offers a competitive benefit package that includes medical, dental, vision, tuition reimbursement, 401(k) and an employee stock ownership plan.

DESCRIPTION

The Director, Audits position is a key leader responsible for providing management oversight and leadership on HSAG’s broad spectrum of audit projects. The Director, Audits will provide operational oversight of all HSAG PMV and HEDIS ® audit activities. On a daily basis, this position manages multiple large-scale and high-profile audit projects through various stages including implementation, day-to-day management, budgeting, forecasting, analysis, and reporting. Activities include overseeing multiple teams in developing work plans and timelines; leading and overseeing project tasks; leading client teleconferences and meetings; presenting on healthcare topics; supervising and/or mentoring junior staff; and providing regular progress reports to the Senior Executive Director, Medicaid Services. The Director, Audits will also lead responses to requests for proposals (RFPs) and implement formal training series for junior and senior staff under the direction of the Senior Executive Director.

Details regarding potential project assignments and key sources of data will be discussed with potential candidates during the interview process.

ESSENTIAL COMPETENCIES, DUTIES, AND 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.

EDUCATION AND/OR EXPERIENCE

• 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, preferably Medicaid.
• Budget and cost proposal development experience, including leading cost proposal development.
• Contract development and review experience.

OTHER QUALIFICATIONS

• 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 evaluating electronic health record and clinical data preferred.
• 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.

[1] HEDIS ® is a registered trademark of the National Committee for Quality Assurance (NCQA).