Manager - Healthcare Operations Audit

3 days ago

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HealthAxis Group

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HealthAxis Group is a technology solutions provider specializing in healthcare administration. Their cloud-native platform, AxisCore™, streamlines health plan management through solutions like claims processing and benefit administration, designed to enhance operational efficiency. HealthAxis offers a suite of services including Business Process as a Service (BPaaS), consulting, and staff augmentation. The company's approach focuses on scalability, compliance, and tailored support, aiming to empower healthcare organizations to meet member needs effectively.

Claims Processing Software • Business Process Outsourcing (BPO) • Third Party Administrative Services • business process as a service (BPaaS) • Core Administrative Processing

201 - 500 employees

Founded 1965

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

📋 Description

• The Manager, Healthcare Operations Audit is responsible for overseeing and managing the audit function within the health plan, ensuring compliance, accuracy, and operational efficiency across all relevant business processes. • This role is essential in assessing and auditing key operational areas such as Utilization Management (UM), claims processing, call center operations, administrative functions, and other health plan services. • The Audit Manager leads a team of auditors, provides strategic insights into audit findings, and drives process improvements based on audit results. • Additionally, the role ensures that audits comply with all relevant regulatory requirements, internal policies, and industry best practices.

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Business Administration, Nursing, or a related field (required). • Master’s degree in Healthcare Administration, Business Administration, or a related field is preferred. • Professional certifications such as Certified Internal Auditor (CIA), Certified Healthcare Auditor (CHA), Certified Professional in Healthcare Quality (CPHQ), or similar certifications are highly desirable. • A minimum of 5-7 years of experience in healthcare operations, auditing, or compliance, with at least 2-3 years in a managerial or leadership role within health plan operations or managed care organizations. • Extensive experience auditing key healthcare functions, including Utilization Management (UM), claims processing, customer service, call center operations, and other administrative services. • Proven track record of leading and managing audit teams, developing audit plans, and delivering insights into operational and compliance performance. • Experience with regulatory requirements such as CMS, NCQA, and state-specific healthcare regulations. • A demonstrated ability to assess risk, identify opportunities for improvement, and drive actionable change based on audit results. • Strong leadership and team management skills, with the ability to motivate and guide audit teams to achieve objectives. • Excellent analytical and problem-solving skills, with the ability to assess complex operational processes and identify areas for improvement. • Exceptional verbal and written communication skills, including the ability to present audit findings and recommendations to senior leadership and other stakeholders. • High attention to detail and the ability to maintain accuracy and quality in all audit-related activities. • Proficiency with audit management software, healthcare management systems, and MS Office Suite (Excel, Word, PowerPoint). • Strong knowledge of healthcare claims processing and customer service operations is essential. • Ability to manage multiple priorities and deadlines in a fast-paced, dynamic environment.