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The Vice President, Quality & Controls Assurance reports to compliance leadership, and strategically and operationally leads various quality reviews of claims, Hierarchical Condition Categories (HCC) and clinical coding, call monitoring, system technology upgrades, and other critical compliance/financial/operational controls and processes across the CCA enterprise, including all health plan and care delivery activities.
These responsibilities include planning, executing, and evaluating results of quality audits/reviews and control/operational integrity initiatives, evaluating error patterns and trends, and ensuring the reporting of relevant quality audit/review results, pre-payment and post-payment claim reviews, call monitoring reviews, and evaluation of HCC audits/reviews, among others, to relevant departments.
The role also leads the department's focused review and internal controls assurance; SOX/SOC/MAR (Model Audit Rule) testing/assurance; technology/systems assurance; external and regulatory audit management, support and facilitation; and CAP remediation teams.
The role and department evaluate statistical patterns and trends of quality and controls assurance results, and collaborate with owners of audited/reviewed business areas to address root causation of errors and facilitate overall quality improvement. The leader additionally oversees special projects as identified by executive management, including but not limited to special regulatory reviews, operational/compliance control assessments, financial internal controls, and other such process- and control-improvement matters.
Supervision Exercised:Yes
Required Education:
Desired Education:
Licensing:
Experience Required:
Knowledge, Skills & Abilities Required:
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Full Time
Business Services
$190k-244k (estimate)
05/27/2024
07/26/2024
commonwealthcarealliance.org
BRIGHTON, MA
100 - 200
2003
Private
$1B - $3B
Business Services