Quality Assurance Lead

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit Amida Care for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative and experienced leader to join our team as the Quality Assurance Lead. Compensation will be commensurate with experience.

Position Summary:

The Quality Assurance Lead will be a SME (Subject Matter Expert) in auditing and workflow implementation. This role conducts regular reviews and audits of internal controls and processes within the Provider Services Department and makes recommendations for improvement and identify areas of risk.

Responsibilities:

• Audit assigned functions in the Provider Service's Team for accuracy, contract interpretation, and compliance with policies and procedures.
• Responsible for identifying and documenting transactions by utilizing departmental quality monitoring templates in a timely manner to ensure prompt resolution.
• Assists in development of special department projects and participates in department and divisional projects.
• Act as a subject matter expert to ensure all Provider Services team members are meeting our quality expectations.
• Collaborate with team members, recommend, develop, and implement process improvements based on collected data that can be used as benchmark measurements.
• Create and manage dashboards and report for QA metrics/KPIs.
• Proficiency with MS Office Products (Word, Excel, And PowerPoint, & Project).
• Performs regularly scheduled internal audits and ensures policies align with workflow processes.
• Must be able to effectively communicate and provide positive customer service internal and external) customer, including customers who may be demanding or otherwise challenging.
• Responsible for appliable compliance and regulatory and related tasks.
• Facilitate meetings related to workflow, training, and process improvement.
• Identify potential trends, and correct root causes for organization's provider systems data issues.
• Perform other duties as assigned.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

EDUCATION REQUIRED

• Bachelor's degree in health care administration, business or an equivalent combination of education and work experience in managed care or health care.

EXPERIENCES AND/OR SKILLS REQUIRED

• Minimum of 5 years' experience in health care, preferably Medicaid; including a minimum of 3 years in a Provider Services/Network position.
• Minimum 3 years' auditing or Quality Assurance experience.
• Proficiency in Microsoft Office software (Word, PowerPoint, Excel).
• Excellent communication skills both written and verbal.
• Extensive analytical and problem-solving skills.
• Strong organizational and project management skills.
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization's vision, mission, and values.