Team Lead, Integrated Dual Audit
Job Summary:
The Team Lead, Integrated Dual Audit will oversee the Integrated Dual Audit team that completes case file reviews to ensure adherence to regulatory requirements and standard operation procedure.
Essential Functions:Provide support for Medicare and Medicaid audit preparation.
Collaborate with Quality /Accreditation to support NCQA LTSS requirements.
Develop and manage audit team schedules, workload allocation and productivity metrics.
Provide ongoing training, mentoring, coaching and disciplinary actions for direct reports as needed.
Engage direct reports through consistent performance feedback and development opportunities.
Ensure compliance with adherence to regulatory requirements and identified Standard Operating Procedures (SOPs) through monthly inter-rater reliability monitoring of Auditor team.
Identify training opportunities and work collaboratively with Care Management to develop the needed education and/or training.
Oversee monthly aggregated reporting of audit results.
Serve as subject matter expert (SME) in integrated dual audit processes.
Support Case Management (CM) in interdepartmental meetings/workgroups to ensure that new operational procedures and updates are aligned with contract requirements.
Assist leadership in meeting monitoring, accreditation and operational responsibilities to ensure adherence to regulatory requirements.
Drive continuous improvement efforts by identifying best practices and leading initatives.
Collaborate with the internal Incident Management program team to support the investigation process related to member health and safety and provide updates to the IM system.
Provide support as needed for the program descriptions/models of care to ensure compliant submissions for the dual products line of business.
Coordinate organizational participation in federal and state contract and regulatory audits and site visits.
Perform any other job related duties as requested.
Education and Experience:Associates degree required
Bachelor's degree preferred
Equivalent years of relevant work experience may be accepted in lieu of required education
Three (3) years Managed Care experience required
Two (2) years Audit Experience required
Previous supervisory experience preferred
Competencies, Knowledge and Skills:Intermediate proficiency in Microsoft Excel, Access and Word
Intermediate skill level with SharePoint
PowerPoint and Visio knowledge preferred
Strong written and verbal communication skills
Ability to work independently and within a team environment
Familiarity of the healthcare field
Knowledge of Medicaid and Medicare
Effective listening and critical thinking skills
Strong interpersonal skills and high level of professionalism
Effective problem solving skills with attention to detail
Ability to develop, prioritize and accomplish goals
Licensure and Certification: None
Working Conditions:General office environment; may be required to sit or stand for extended periods of time
Travel is not typically required
Compensation Range:
$72,200.00 - $115,500.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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