Team Lead, Integrated Dual Audit

Job Summary:
The Team Lead, Integrated Dual Audit will oversee the Integrated Dual Audit team that completes case file reviews to ensure adherence to regulatory requirements and standard operation procedure.

Essential Functions:

• Provide support for Medicare and Medicaid audit preparation.
• Collaborate with Quality /Accreditation to support NCQA LTSS requirements.
• Develop and manage audit team schedules, workload allocation and productivity metrics.
• Provide ongoing training, mentoring, coaching and disciplinary actions for direct reports as needed.
• Engage direct reports through consistent performance feedback and development opportunities.
• Ensure compliance with adherence to regulatory requirements and identified Standard Operating Procedures (SOPs) through monthly inter-rater reliability monitoring of Auditor team.
• Identify training opportunities and work collaboratively with Care Management to develop the needed education and/or training.
• Oversee monthly aggregated reporting of audit results.
• Serve as subject matter expert (SME) in integrated dual audit processes.
• Support Case Management (CM) in interdepartmental meetings/workgroups to ensure that new operational procedures and updates are aligned with contract requirements.
• Assist leadership in meeting monitoring, accreditation and operational responsibilities to ensure adherence to regulatory requirements.
• Drive continuous improvement efforts by identifying best practices and leading initatives.
• Collaborate with the internal Incident Management program team to support the investigation process related to member health and safety and provide updates to the IM system.
• Provide support as needed for the program descriptions/models of care to ensure compliant submissions for the dual products line of business.
• Coordinate organizational participation in federal and state contract and regulatory audits and site visits.
• Perform any other job related duties as requested.

Education and Experience:

• Associates degree required
• Bachelor's degree preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Three (3) years Managed Care experience required
• Two (2) years Audit Experience required
• Previous supervisory experience preferred

Competencies, Knowledge and Skills:

• Intermediate proficiency in Microsoft Excel, Access and Word
• Intermediate skill level with SharePoint
• PowerPoint and Visio knowledge preferred
• Strong written and verbal communication skills
• Ability to work independently and within a team environment
• Familiarity of the healthcare field
• Knowledge of Medicaid and Medicare
• Effective listening and critical thinking skills
• Strong interpersonal skills and high level of professionalism
• Effective problem solving skills with attention to detail
• Ability to develop, prioritize and accomplish goals

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:

$72,200.00 - $115,500.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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