Manager QA and Reporting

MANAGER QA & REPORTING (HEALTHCARE)

Hybrid (In office 3 days/week) within Oregon, Washington, Idaho or Utah 

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For: 

Every day, Cambia’s Operations and Compliance Team is living our mission to make health care easier and lives better. The Manager of Quality Assurance And Reporting directs, develops and leads the staff accountable for providing Health Plan Operation Quality Assurance Auditing and Reporting. Accountable for the timely and accurate external corporate reporting for the Blue Cross Blue Shield Association (BCBSA) Local Operations Scorecard (LOS) and Licensee Desk Level Audit (LDLA), as well as Performance Guarantee performance measures. Responsible for the interpretation of LOS, LDLA, and PG policies and regulations and for the implementation of the necessary statistically valid audit procedures to assess these performance measures. May also be responsible for internal high dollar prepay, staff performance auditing activities, external audit support, or compliance audits. Responsible for writing audit programs, evaluating audit results, and reporting to internal Senior Management any quality issues and areas where quality improvement is needed. Primary business contacts include BlueCross BlueShield Association, affiliate Plan LOS or LDLA peers, Member and Provider Experience, Claims, Group and Member Administration, DTS, and Provider Services Division management – all in service of making our members’ health journeys easier.  

If you're a motivated and experienced QA & Reporting Leader looking to make a difference in the healthcare industry, apply for this exciting opportunity today!

What You Bring to Cambia: 

Preferred Key Experience:

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired 

Qualifications and Certifications:  

• Bachelor's degree in Business, Accounting, Health Care, Management or related field

• Five years of experience in claims, membership, or customer service activities is desired

• minimum three years experience in a leadership or supervisory position

• Equivalent combination of education and experience

Skills and Attributes (Not limited to):  

• Ability to communicate effectively, verbally and in writing with all levels of Cambia personnel.

• Ability to lead and participate in a team environment to achieve department goals and objectives consistent with corporate vision and strategies.

• Ability to interpret regulations and external reporting requirements, plan for and successfully implement changes in LOS, LDLA, performance guarantee, and staff performance audit requirements, including appropriate sampling methodology, audit oversight, and concise and accurate reporting.

• Knowledge of audit techniques and statistical sampling methods and procedures including sample sizes, variances, confidence levels, random and stratified sampling, and precision levels.

• Knowledge of generally accepted auditing procedures and practices, obtained through an auditing course or prior work experience.

• Knowledge of quality tools and quality improvement methodologies.

• Demonstrated effective and diplomatic interpersonal skills with all levels of staff and management

• Demonstrated analytical ability in identifying problems, developing solutions and implementing effective courses of action.

• Ability to think clearly under pressure and project a professional image at all times.

• Strong proficiency with personal computer applications including Microsoft Excel, Word, and PowerPoint.

What You Will Do at Cambia (Not limited to):   

• Responsible for developing and implementing quality audits throughout Health Plan Operations to ensure that quality service levels are met or exceeded.

• Prepares and maintains reference manuals and audit programs/procedure guidelines for all Quality Assurance audits and reports.

• Maintains knowledge of the BlueCross and Blue Shield Association LOS Program, LDLA, and Performance Guarantee Audit measures, standards and reporting procedures.

• Analyze and report audit results using graphs/trending in order to highlight and prioritize quality improvement opportunities.

• Identify error trends and work with b