Operations Quality Assurance Audit Manager
Current- The Claims Audit Unit transitioned from Internal Audit to Operations to create a new department focused on quality, operational process improvement opportunities, and compliance to Medicare/Medicaid requirements and.
- Monthly audits of TMPSCO and TMPHMO claims, for compliance to CMS requirements and regulations.
- Additional weekly audits or TMPSCO claims to provide feedback on administration of TMPSCO as it pertains… Show more The Claims Audit Unit transitioned from Internal Audit to Operations to create a new department.
- Additional weekly audits or TMPSCO claims to provide feedback on administration of TMPSCO as it pertains to internal policies and procedures as well as Medicare/Medicaid regulations.
- Provide internal reporting for performance guarantees with employer groups.
- Work with Operations management team and numerous departments throughout the organization to address process improvement opportunities, directly impacting quality scores.
Apr 2011 - Present
