45 to 60K DOE

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Performs quality review of operational departments including member enrollment and disenrollment activities

 

 

• Helps identify root cause with Business Unit Owners.

 

 

• Provides statistical analysis based on audit results for dissemination to management for use in identifying knowledge deficits and productivity issue

 

 

• Identifies functional area deficiencies.

 

 

• Prepares, reviews, updates and monitors Standard Operating Procedures, with input from Subject Matter Experts (SMEs), to ensure proper process documentation, as well as compliance with CMS regulations.

 

 

• Reviews departmental policies and procedures to ensure compliance with functional and operational guidelines.

 

 

• Provides support for internal and external regulatory audits, reviews and site visits.

 

 

• Identifies potential compliance risks and recommends opportunities for improvement.

 

 

• Reviews and familiarizes self with Medicare operating materials, memorandums, and guidance to ensure regulatory compliance.

 

 

QUALIFICATIONS

• Knowledge of quality assurance principles, practices and procedures and ability to apply this knowledge to the planning and accomplishment of a variety of work assignments.

 

 

• Ability to apply sampling methods.

 

 

• Ability to research, analyze, interpret and apply rules, regulations, and procedures.

 

 

• Ability to interpret Federal and State laws and regulations.

 

 

• 4 year degree, Accounting, Finance or Business

 

 

Diane Delgado LeMaire|

　Senior Managing Director, Accounting & Finance Recruiting | Creative Financial Staffing, a division of Fitts, Roberts CPA Firm | 5718 Westheimer Suite 800 | Houston, TX 77057 |713-260-5238 | dcd@fittsroberts.com