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 p