https://amzn.to/44P6GXZ
The Vice President, Quality & Controls Assurance reports to compliance leadership, and strategically and operationally leads various quality reviews of claims, Hierarchical Condition Categories (HCC) and clinical coding, call monitoring, system technology upgrades, and other critical compliance/financial/operational controls and processes across the CCA enterprise, including all health plan and care delivery activities.
These responsibilities include planning, executing, and evaluating results of quality audits/reviews and control/operational integrity initiatives, evaluating error patterns and trends, and ensuring the reporting of relevant quality audit/review results, pre-payment and post-payment claim reviews, call monitoring reviews, and evaluation of HCC audits/reviews, among others, to relevant departments.
The role also leads the department’s focused review and internal controls assurance; SOX/SOC/MAR (Model Audit Rule) testing/assurance; technology/systems assurance; external and regulatory audit management, support and facilitation; and CAP remediation teams.
The role and department evaluate statistical patterns and trends of quality and controls assurance results, and collaborate with owners of audited/reviewed business areas to address root causation of errors and facilitate overall quality improvement. The leader additionally oversees special projects as identified by executive management, including but not limited to special regulatory reviews, operational/compliance control assessments, financial internal controls, and other such process- and control-improvement matters.
Supervision Exercised:Yes
What You’ll Be Doing:
What We’re Looking For:
Required Education:
Desired Education:
Licensing:
Experience Required:
Knowledge, Skills & Abilities Required:
Language(s):
Other Requirements:
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.
Job ID: 359045 About the Job Position Overview The Department of Curriculum and Instruction, College of Education and Human Development,...
Apply For This JobVILLAGE OF SCHAUMBURG Human Resources Department 101 Schaumburg Court,Schaumburg, IL 60193 The Village of Schaumburg is a thriving community of...
Apply For This JobJob Location: New Rochelle – New Rochelle, NY Position Type: Part Time Education Level: Masters Degree Salary Range $1,200.00 –...
Apply For This JobJob Number: REQ_0000052620 APPLICATION INSTRUCTIONS: CURRENT PENN STATE STUDENT (not employed previously at the university) and seeking employment with Penn...
Apply For This JobIntroduction: The University of Jamestown invites applications for a full-time faculty position in our Teacher Education program. The position is...
Apply For This JobSoftware Engineer (DevOps) We are seeking a results-driven and team-oriented professional with broad technical skills and a high degree of...
Apply For This Job