Director, Audit Training & Quality Assurance

ABOUT PERFORMANT:

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

ABOUT THE OPPORTUNITY:

Hiring Range: $125-145k base salary

The Director of Audit Training & Quality Assurance plays a key leadership role in building and sustaining high performance across all medical review audit functions through a robust, effective training program and quality assurance program.  In addition to leading and developing training programs, this role also creates effective and high functioning QA programs, ensuring the on-time delivery of high-quality audit quality assurance (QA) oversight, ensuring organizational goals are met.  The Director will provide support and oversight of multiple personnel and job functions – including Coding, Nursing, Document Reviewers, automated software and/or other Clinical specialties – with regard to quality assurance of audit determinations rendered by team members working in these roles. This experienced leader is focused on optimizing operational efficiency, quality, profitability and overall service delivery to clients. 
 

Key Responsibilities to include:

• Make a positive impact in the optimization of claim audit services by leveraging your expertise in Payment Integrity claims auditing, coupled with breadth of operational knowledge, adaptable skillset, experience leading teams and building educational programs.

• Responsible for operational training, including training related elements arising from and related to nurse auditors, coders, QA, Appeals, Operations Support Services and tools (operational policies/procedures/workflow) and adapting for each client’s unique requirements.

• Collaborates with peers and program leaders for continuous improvement and progressive approaches to strategies and infrastructure for audit services.

• May serve as a named resource and/or practice lead for specific business segment or operations specialty/support function on an ongoing or interim basis as may be needed.

• Builds, manages, and develops effective teams, which may be composed of supervisory and/or individual contributor roles (exempt and/or non-exempt).

• Maintains in-depth knowledge and remains up to date with ongoing and sometimes rapid changes to client and regulatory requirements, as well as internal changes for all operational elements related to client programs.

• Ensure resources for assigned areas are staffed appropriately scalable to operational demands.

• Ensure team is accountable for following company policies, procedures, and requirements, as well as managing staff in accordance with management requirements, work volume, and budgetary requirement.

• Builds Performant’s value and credibility internally and externally, and represents the organization in meetings with the client, provider organizations, contractors, subcontractors, and vendors as required.

• Performs other duties as assigned.

• Collaborates with Medical Directors, Subject Matter Experts and Audit leadership to develop and document internal audit standards to align with individual audit concepts, claim types and client-specific policies.

• Prepares reports and manages Quality Assurance activities for assigned clients, including the daily management of inventories to ensure adherence to all client and internal Service Level Agreements pertaining to Turn Around Times and Quality.

• Applies in depth level of expertise in development of policies and procedures and workflows processes to formulate QA plans, ensure adequate training of QA staff, documentation of QA findings, development of meaningful feedback to appropriate areas of the business and to ensure staff accurately identify processing, procedural, systemic and billing errors and practices leading to claims inaccuracies.

• Manages team members performing audit QA activities to identify trends, determine root cause of payment inaccuracies, monitor the quality of auditor findings and to recommend process and systems improvements.

• Proactively identifies opportunities for process improvement, efficiency, resolving problems, preparing and completing action plans.

• Supports subcontractor communication, oversight and reporting.

• Establishes accountability for performance monitoring (productivity/quality), communicates job expectations, trends, documentation, and ensures timelines are met.

• Supports strategy by conducting needs assessments, capacity planning, cost/benefit analyses; preparing staffing models, establishing productivity and quality standards.

• Maintains professional and technical knowledge by tracking emerging trends in audit management; attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.

• Develops effective relationships with leaders in the organization and has a strong understanding of the business

• Builds value and credibility with internal and external clients and represents the organization in meetings with the client, provider organizations, contractors, subcontractors and vendors.

• Performs other duties as assigned.

Knowledge, Skills and Abilities Needed:

• Depth and breadth of industry and operational knowledge and experience with medical claim research, analysis, nursing, coding, medical review auditing, billing procedures, recovery, medical terminology and medical coding; preferably in a role with responsibility for developing and enhancing tools and resources used to measure, evaluate, audit, train, and develop staff performing the same.

• Understanding of and prior experience with Adult Learning Principles/Theories.

• Demonstrated ability to leverage operational data and diverse inputs of varying sources to identify areas and develop action plans for improvement of infrastructure and programs to optimize operational results.

• Demonstrated skills and success developing and managing resources, tools, and programs for operations to ensure high quality, productivity, and continuous improvement of service delivery for clients.

• Demonstrated success leading and collaborating on initiatives and programs to support best practices and continuous improvement of operational infrastructure (process, procedures, workflow, policies, assessment, reporting, tools, etc.).

• Remarkable interpersonal skills that lends to positive interactions with staff, peers, leadership, and stakeholders; servant leadership attitude and demonstrated ability to resolve conflict in a professional manner.

• Excellent presentation skills and ability to lead group activities and discussions that result in effective knowledge transfer, development, and/or desired business outcomes; ability to train others in these skills is also necessary.

• Demonstrated ability to develop effective training materials and tools; break-down large volumes of information and sometimes complex concepts into smaller components and materials that contributes to effective knowledge transfer and skill development of operational staff.

• Strong project management and interpersonal skills, makes sound decisions, exhibiting initiative and intuitive thinking. Consulted often by others for advice and opinions and recognized as a leadership role model.

• Possess a broad and comprehensive understanding of audit standards, policies and regulations, applies a broad and comprehensive knowledge in areas including, medical chart reviews.

• Demonstrated ability to consistently apply sound judgment and good effective decision making.

• Excellent communication skills, both verbal and written; ability to communicate effectively and professionally at all levels within the organization, both internal external.

• Demonstrated ability to collaborate effectively in a variety of settings and topics.

• Excellent editing and proofreading skills.

• Ability to independently organization, prioritize and plan work activities effectively for self and others; develops realistic action plans with the ability to multi-task effectively.

• Excellent time management and delivers results balancing multiple priorities.

• Strong analytical skills; synthesizes complex or diverse information; collects and researches data; uses experience to compliment data.

• Leverages strong critical thinking, questioning, and listening skills to research and effectively resolve complex issues.

• Demonstrated ability to be proactive; identifies and resolves problems in a timely manner; develops alternative solutions.

• Strong general technical skills, including, but not limited to: Desktop and MS Office applications (Excel, PowerPoint, Word, Outlook, etc.), application reporting tools, and others.

• Solid technical aptitude with demonstrated ability to quickly learn and adapt to new systems and tools.

• Ability to be flexible and thrive in a high pace environment with changing priorities.

• Adaptable to applying skills to diverse operational activities to support business needs.

• Serves as positive role model, and demonstrates characteristics that align and contribute to a collaborative culture of continuous improvement and high performing teams.

Required and Preferred Qualifications:

• Bachelor’s degree in Health Science, Business Management, Healthcare Administration, or related.  In the absence of a completed degree, a significant combination of experience and formal training/certifications, may be considered.

• Registered Nurse (RN) license and/or Medical Biller/Coder certification is strongly preferred; Quality or Training certification is a plus.

• 10+ years of professional experience in healthcare with increasing responsibilities directly relevant to the scope of this role.

• 3+ years relevant supervisory or leadership experience in similar business environment/industry.  Experience managing remote staff is preferred.

• Experience working in role with responsibility for development and delivery of training programs; knowledge of and demonstrated experience working with Adult Learning Principles.

• Prior experience overseeing audit or QA-related operations, including responsibility for inventory assignments, SLA management and communication of audit results.

• Expert level knowledge of medical terminology, billing, and coding.

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required.  Proof of such may be required prior to an offer being made.  It is the Employee’s responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

Performant is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions).   Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times.  Violations to Performant’s policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Performant is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Performant’s Human Resources team to discuss further.

Our diversity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED