Mgr, Quality, Audit & Reporting
- Recruiter
- Horizon Healthcare Services, Inc
- Location
- Newark, New Jersey, United States
- Salary
- Competitive salary
- Posted
- 24 Sep 2020
- Closes
- 25 Sep 2020
- Ref
- 2019-1307
- Job role
- Audit
- Sector
- Accounting - Public practice
Job Summary:
Responsible for the creation and execution of quality audit reports for the Government Programs products and coaching plans for new hires, existing employees, enterprise projects and service initiatives. Align resources to the business teams and vendor partners to support daily functions, nesting, and identification of trends, gap analysis and remediation. Monitor team performance against enterprise and divisional goals and make recommendations to close gaps.
Education:
Work experience:
Specialized knowledge/skills:
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.
Responsible for the creation and execution of quality audit reports for the Government Programs products and coaching plans for new hires, existing employees, enterprise projects and service initiatives. Align resources to the business teams and vendor partners to support daily functions, nesting, and identification of trends, gap analysis and remediation. Monitor team performance against enterprise and divisional goals and make recommendations to close gaps.
- -Oversee the management of respective databases to ensure data is updated and any maintenance requirements are being reviewed.
- -Development and execution of coaching plans on a monthly and quarterly basis based on business requests.
- -May develop, administer and monitor coaching activities for all divisional new hire and existing employees as well as the offsite vendor partners.
- -Identify training and development needs through trending analysis, business partner requirements and service initiatives partner with Training and Development to share results.
- -Develop and support business partnerships and represent department/enterprise with internal customers and vendor partners where appropriate.
- -Conduct detailed analysis to determine root cause analysis in connection with deficiencies sited in Government Programs Audits; develop and implement corrections.
- -Design/implement audit plan for new Government Program audits.
- -Ensure Service Level Agreements (SLAs) are followed both internally and with vendors, educate vendors on policies & practices, monitor vendor compliance.
- -Identify, communicate and implement Best Practices across the enterprise as well as new audit initiatives, process improvements and any other observations discovered during the audit process which may impact Enterprise Operations.
- -Present to stakeholders recommendations and enhancements of underlying processes to improve company performance.
- -Oversee external audits by government regulators to ensure accuracy of findings.
- -Accountable for maintaining effective internal controls over the processes and transactions under areas of responsibility including the completeness and accuracy of financial information and transactions, compliance with applicable laws and regulations, and the effectiveness and efficiency of operations.
- -Design and build job function dashboards, reports, models and visualizations to share data on fundamental measures of organizational success to maximize insight and action for internal/external customers.
- -Interpret, create final recommendations based on trend reporting to close operational gaps; present the results to key stakeholders and business owners.
- -Continuously identify processes to automate/eliminate reports by applying business process improvement and process reengineering to the report development.
Education:
- Bachelor's Degree Required.
Work experience:
- A min of 5 yrs supervisory experience in a relevant capacity.
- A min of 3 years data building and reporting experience
- A min of 3 years Government Programs (Medicaid, DSNP, MLTSS) experience
- A min of 3 years working knowledge of FACETS.
Specialized knowledge/skills:
- Healthcare knowledge, service operations, Managerial skills, Health Insurance, Supervisory Development/MDP program.
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.