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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 training to employees as needed and ensures new hires 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. 

Minimum Qualifications:  

• High school diploma or GED
• Strong claims knowledge and internal process knowledge preferred.
• Quality Assurance/Auditing experience 
• 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 auditing capacity conducting root cause analysis. 
• 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. Applicants and employees are considered for positions and are evaluated without regard to 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.

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 careers@Healthfirst.org or 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 Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

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): $81,100 - $117,470

• All Other Locations (within approved locations): $71,600 - $106,505

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.