Location: Monsey,NY, USA
Duties/Responsibilities:Design and execute the operations internal audit strategy to assess financial, operational, and compliance risksLead a team responsible for performing a variety of operational audit functions across business teams, including identifying new and innovative methodologiesDevelop talent to meet departmental objectivesExperience with regulatory standards and internal policiesLead, coordinate, and actively participate in managing audit planning, conducting audits, preparing audit evidence, assessing the quality of audit evidence, and ensuring audit readiness for Operations auditsContribute to executing onsite and/or desk audits and collecting anticipated audit findingsIdentify control weaknesses, potential risks, and opportunities for process improvementWork closely with external auditors and regulatory bodies, ensuring alignment in audit findings and follow-up actionsDevelop and implement quality assurance frameworks and standards across various operationsOversee quality assessments to ensure that customer service, claims processing, and other critical functions meet defined quality benchmarksInstitute reporting and analytics capabilities that provide insights and trends, performance improvement recommendations, sound statistical sampling and audit source dataHelp evaluate technology solutions to identify solutions offering workflow improvement, reporting, analytics, and AIAssist in identifying and implementing robust automated systems to obtain, aggregate and house results with real-time and on-demand reportingAnalyze data from quality assessments to identify trends, areas of improvement, and training needsWork with departments to establish performance metrics and monitor adherence to quality standardsEnsure compliance with healthcare regulations and industry standards, addressing changes in regulatory requirementsRecommend process improvements to enhance operational efficiency and reduce errors or compliance issuesKeep abreast of industry issues and trends to proactively shape Internal Audit, Quality Assurance and Testing practices and proceduresCollaborate with external vendors, ensuring SLAs are met along with all contractual obligationsAdditional duties as assignedMinimum Qualifications:Bachelor's degree from an accredited institution or relevant experienceHS Diploma or GED from accredited institutionWork experience requiring knowledge of an array of NYS and federal rules and guidelines that impact Contact Center Operations, Enrollment and Billing and Claims operations for Medicaid, Medicare, and Commercial lines of business (i.e. contract laws, prompt pay, etc.)Work experience requiring knowledge of Medicaid and MedicarePrevious management and oversight experience of regulatory and compliance initiativesPreferred Qualifications:Substantial experience leading complex, operations-wide initiatives and the development and implementation of impactful audits and root cause analysisScience and research-based knowledge in a variety of topics related to operational auditsStrong facilitation, consulting, and influence skills across a variety of audiencesExceptional verbal and written communications and content: concise, clear, simple, visually appealingProven ability to manage and collaborate with senior stakeholders and across operations teamsProject management experiencePower BI Microsoft software toolCompliance & Regulatory Responsibilities: Noted aboveWE 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, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.