Quality Assurance Manager - Payer Risk Adjustment and Quality Analytics (HEDIS)

Veradigm Payer 

Veradigm understands that managed care organizations, pharmacy benefit managers (PBMs), insurance companies, health plans, and other payers need to balance controlling costs with the goal of providing the highest quality of care and optimizing health outcomes for their members.

Solutions from Veradigm Payers:

• Deliver insights to drive quality outcomes cost-effectively
• Improve efficiency for themselves, their providers, and their members through high-speed clinical data exchange
• Impact point-of-care decision making positively by integrating payer guidance and prior authorization management directly in each healthcare provider’s existing workflow

Job Summary: 

Quality Assurance Manager – Payer Risk Adjustment & Quality Analytics (HEDIS) 

The Development Manager will lead and manage a Quality Assurance team across our Payer Analytics solutions. The Manager will be responsible for defining QA strategy with a special focus on automation, leading and auditing quality assurance initiatives, managing the team and estimating workload, providing high level guidance, and working with development and product management teams to communicate development and release information thoroughly and accurately. 

What you will contribute:

• Define and deliver QA strategy with a special focus on automation 
• Develop and refine Quality Assurance standard operating procedures incorporating industry best practices 
• Provide high level guidance and technical mentorship to team members. 
• Ensure test cases are documented appropriately for user stories and conducted in full prior to deeming the functionality is ready for release 
• Work with business analysts to define, break down, prepare and estimate features and user stories for the sprint team. 
• Ensure all quality, security and compliance processes are followed. 
• Work with the team to meet quality assurance testing milestones. 
• Work collaboratively with the support, operations, development and information systems team to ensure the system is running efficiently and effectively (timely and accurate) 
• Work closely with the operations and technology teams ensuring hand-offs and dependencies are understood and maintained 
• Ensuring commitments and progress to schedules remain clear, reasonable, and proactively monitored 
• Provide regular constructive feedback on performance/development and address subpar performance in a timely manner 
• Recognize high performers to maintain motivation and retain key talent 
• Ownership of end-to-end process improvement efforts as appropriate to project and product need 
• Regular use/reporting of metrics for resource allocation, software defects, productivity, and efficiency 
• Participation in and implementation of established global software quality improvement initiatives and processes, adherence to standards, and timely, measurable results 
• Define, develop and monitor key metric reports to ensure technology is working optimally for customers 

The ideal candidate will have:

Academic and professional qualifications: 

• Bachelor’s degree in computer science or related field or equivalent technical/business experience required  

Experience: 

• 10+ years of Quality Assurance experience from a technology company 
• 5+ years of experience leading Quality Assurance/Development teams in a high growth healthcare technology company 
• Strong understanding of payer subject matter including HEDIS and STAR Ratings quality measures reporting, and risk adjustment  
• Excellent communication skills and ability to interface with both external and internal personnel at all levels 
• Ability to work within a team environment 

Travel Requirements:

• Less than 10% travel for internal meetings and/or client engagements 

Compliance 

Job responsibilities include fostering the Company’s compliance with all applicable laws and regulations, adherence to the Code of Conduct and Compliance Program requirements, policies and procedures. Compliance is everyone’s responsibility.

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