Health Plan Auditor I

• Are you passionate about improving the quality of healthcare?
• Are you ready to leverage your talents to make healthcare better for everyone?
• Do you want the opportunity to give back to your community?
• Do you want to have fun at work?
• Then join the growing team at Health Services Advisory Group (HSAG) that is transforming the delivery of healthcare in the United States!

Job Details

The Auditor is a contributor to the Audits department’s work that spans the broad spectrum of healthcare performance measurement projects at HSAG. Driven by intellectual curiosity and a passion for healthcare quality, this position performs—under supervision—healthcare auditing, data validation, and performance measurement projects through various stages including implementation, day-to-day operations, audit support, evaluation, and reporting. Activities include developing work plans and timelines; overseeing project tasks; guiding coordination staff in oversight and maintenance of project files; leading client teleconferences and meetings; performing online research on healthcare topics; leading primary source verification; validating performance results and outcomes; and providing regular progress reports to Data Science & Advanced Analytics management staff.

Details regarding potential project assignments will be discussed with potential candidates during the interview process.

Essential Competencies, Duties, and Responsibilities

• Serve as a contributing member of HSAG’s Audits department within DSAA.
• Act in a liaison capacity between appropriate management personnel and staff, transmitting decisions and information to organizational units as appropriate, as well as outside agencies and organizations, under supervision.
• Lead project management tasks, including communication (written, phone, fax), under supervision.
• Communicate with project partners, consultants, subcontractors, and other entities on audit and performance measure validation-related projects, under supervision.
• Maintain, tag, and sort documents for assigned projects on appropriate SharePoint team sites and HSAG’s corporate and federal networks following HSAG prescribed governance rules.
• Prepare project deliverables and lead documentation and submission of deliverable using the appropriate mechanism (i.e., electronic, hard copy, direct data entry etc.), under supervision.
• Develop and adhere to project time and task schedules, identify opportunities to improve the project process, and develop quality improvement activities accordingly.
• Meet agreed-upon deadlines in a timely fashion and accurately prepare and type deliverables, reports, various project documents, letters, and other material from copy, rough draft, or other prescribed instructions.
• Support development of written and data-oriented reports in Microsoft Word and Excel, under supervision.
• Conduct research via the Internet including literature searches of clinical topics as assigned.
• Participate in pertinent healthcare educational and training presentations as required.
• Conduct Internal Quality Control (IQC) monitoring regarding efficiency/effectiveness of activities conducted. Present issues and recommended solutions and take corrective actions as indicated.
• Serve as a reference to HSAG staff and clients on Healthcare Effectiveness Data and Information Set (HEDIS®)[1] measures and non-HEDIS performance measures as applicable.
• Represent HSAG in a professional manner at all times.

• [1] HEDIS Certified Measures® is a registered trademark of the National Committee for Quality Assurance (NCQA).
• Required Education and/or Experience

• Bachelor’s degree in business, science, or healthcare-related field.
• At least one year of work experience in healthcare is required; two years of work experience in healthcare is preferred.
• At least one year of auditing experience is required.

Other Qualifications

• Proficient English/communication skills (i.e., public speaking, spelling, composition, grammar, proofreading and editing).
• Proficient interpersonal skills.
• Experience in Microsoft Word, PowerPoint, and Outlook.
• Experience in Microsoft Excel.
• Experience in conducting research via the Internet.
• Ability to handle several projects simultaneously and work with multiple teams.