Director, Audits (Healthcare)

Required

• Present and communicate project results to nonanalytic staff members and customers.
• Represent HSAG in a professional manner at all times.
• 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.
• 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.