Associate Director Quality Assurance

Profile

Description

The Associate Director, Quality Assurance for Humana/Your Home Advantage (YHA) develops and implements programs to establish and maintain quality standards of existing products and services pertaining to In Home Wellness Assessments. The Associate Director, Quality Assurance requires a solid understanding of medical documentation and coding, organizational capabilities and clinical care delivery.

Responsibilities

The Associate Director, Quality Assurance


ensures timeliness and production of clinical coding team, reviews escalation cases and oversees audits
monitors clinical and quality metrics utilizing PowerBi dashboards and provides clear, concise reporting on daily/weekly basis to YHA Leadership
serves as the Liaison between YHA and Humana Business partners to include MRA, STARS, Healthcare Services (HCS) and Pharmacy Solutions
is an active and engaged member of biweekly and monthly Quality meetings with YHA leadership and with other Humana Business Partners and Leaders
is the Subject Matter Expert (SME) for clinicians (PA/NP) and provides clinical oversight and administration
will lead a team of up to 15 direct reports.


Required Qualifications


Bachelor's Degree (preferably in healthcare)
RN or LCSW
2 or more years of clinical experience
1-2 years of management or leadership/supervisory experience


Preferred Qualifications


Strong experience in ICD-9, ICD-10 and CPT coding
Highly proficient with Microsoft Office products
Strong written and verbal communication skills; strong analytical, organizational and time management skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
ICD-10 Certification
Certified Medical Coder with one of the following active certifications and with a high degree of competency (CPC, CPC-H, or CPMA from AAPC; or CCA, CCSP, CCS from AHIMA)
MRA and HEDIS knowledge
Open to travel to YHA market offices (Tampa,FL; Deerfield Beach,FL; Louisville, KY)


Scheduled Weekly Hours

40

Company info

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