Total 2 Senior Executive level Quality Assurance / Control job vacancies in Phoenix,AZ

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Great careers are built at Banner Health. There’s more to health care than doctors and nurses. We support all staff members as they find the path that’s right for them. Apply today, this could be the perfect opportunity for you.

Becker’s Healthcare recently honored Banner as one of 150 top places to work in health care for 2023, we are proud to offer our team members many career and lifestyle choices throughout our network of facilities. At Banner Health, we’re excited about what the future holds for health care. That’s why we’re changing the industry to make the experience the best it can be. If you’re ready to change lives, we want to hear from you.

The role is Monday - Friday 8 AM - 5PM, the location is remote and the team is open to out of state candidates but would like their team to be available to be onsite once per quarter. In this role you will be responsible for managing audits, mentoring staff, and managing reporting for all Banner plans and networks. If you have audit experience with knowledge in health plans and healthcare this would be an ideal role for you!

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits.

POSITION SUMMARY
This position conducts scheduled audits defined in the annual audit plan, as well as, requested unplanned audits resulting from an internal request or a government investigation. Plans, coordinates and manages audits and third party investigations under the direction of compliance leadership. Conducts coding, billing and other business procedure audits and prepares and presents reports of findings at the direction of compliance leadership. Assists with the development of corrective actions and monitoring activities to mitigate risk and validate ongoing compliance with government regulatory requirements. Conducts internal investigations reported though the compliance/ethics line as applicable, assists the organization’s compliance officers as directed to research and investigate concerns or questions related to compliance or regulatory requirements. Provides support to compliance leadership during government investigations, including document indexing, medical record review, research regarding applicable laws and regulatory requirements, internal policies, procedures/operational processes and maintaining investigation file integrity.

CORE FUNCTIONS
1. Researches regulatory requirements relative to assigned audits and develops audit tools. Conducts audits utilizing defined audit standards, communicates the audit process through a pre-audit conference, identifies areas of potential risk, prepares audit reports, communicates results though an audit exit conference, assists in the development of corrective action plans, monitors effectiveness of corrective action plans, and provides training if indicated.

2. Identifies training opportunities based on audits, designs and presents such education to prevent repeated compliance risks at the direction of the compliance leadership team. Provides compliance/documentation education sessions to physicians and other staff.

3. Coordinates external investigation efforts in conjunction with the Banner Legal Department and Compliance leadership. Maintains investigation integrity by managing investigation files, reviewing applicable laws and regulations, Banner internal policies and relative operational processes.

4. Assists the organization's compliance leadership, as directed, to research and investigate complaints, concerns or questions relative to compliance issues. Investigates and follows up on reported issues as directed.

5. Maintains awareness of laws and regulations and conducts research as needed to identify applicable laws, regulations and practices to maintain compliance. Reviews related policies and procedures and literature. Communicates applicable compliance issues to the compliance officers and assists in the distribution of training of such changes.

6. Assumes additional responsibilities to assist and support the organization's compliance program often dealing with complex and unique situations and problems.

7. Performs job functions on a system-wide basis. Internal and external customers include, but are not limited to, executives and managers, compliance committees, physicians and clinical staff. Must maintain relevant professional licensure/certification.



MINIMUM QUALIFICATIONS

Requires knowledge typically gained with completion of a bachelor's degree in business, nursing, internal audit or related field.

Requires skills and abilities normally acquired with two to three years of payer, clinical or healthcare operations experience and/or three to five years of experience in medical coding or audit experience within a complex care or payer environment. Must be able to understand, apply and interpret complex rules and regulatory requirements in a variety of payer or provider settings and relevant healthcare-related government regulations, including Medicare and Medicaid.

Requires clinical or payer knowledge, critical and analytical thinking skills to conduct compliance audits and draft reports. Written and verbal communication skills required. Computer skills in word processing and spreadsheets required. Ability to organize workload, manage multiple projects, and maintain confidentiality of all work information.

PREFERRED QUALIFICATIONS

Relevant certification based on assigned area of focus. Experience in Payer or Healthcare operations, regulatory requirements, legal, revenue cycle, coding registered nurse (RN) or audit standards preferred as relevant to the position.

Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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Job Description:

At Bank of America, we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we deliver for our clients, teammates, communities and shareholders every day.

One of the keys to driving Responsible Growth is being a great place to work for our teammates around the world. We’re devoted to being a diverse and inclusive workplace for everyone. We hire individuals with a broad range of backgrounds and experiences and invest heavily in our teammates and their families by offering competitive benefits to support their physical, emotional, and financial well-being.

Bank of America believes both in the importance of working together and offering flexibility to our employees. We use a multi-faceted approach for flexibility, depending on the various roles in our organization.

Working at Bank of America will give you a great career with opportunities to learn, grow and make an impact, along with the power to make a difference. Join us!

Job Description:

This Senior Operations Control Specialist role is on the Consumer AML High Risk Detection team within Global Operations.

Conducts routine to complex research and investigations in diversified operations to support compliance operations directed by internal bank policies and required adherence to regulatory and compliance requirements which can involve high penalties and fines for non-compliance. Executes against regulatory, BSA/anti-money laundering, and economic sanctions compliance practices relevant to the specialists specific area of responsibility with sufficient expertise and or experience to require some direction, but little day-to-day guidance from the specialist's manager.

This job is responsible for supporting the day-to-day routines of teams that deliver against the bank's Financial Crimes Enterprise Policy and the Financial Crimes Global Standard. Key responsibilities include understanding and anticipating inherent risks to the business, applying knowledge by conducting research and analysis in multiple applications to solve complex problems and escalation inquiries, documenting procedure changes, providing guidance to employees, and effectively communicating information and data across the Line of Business.

Responsibilities:

• Monitors team metrics and works with leadership to track progress towards objectives and ensure goals are met

• Demonstrates process expertise and provides support to leadership, employees, and business partner by implementing process improvements to address and resolve issues

• Assists in the identification, escalation, and mitigation of potential risks and issues

• Applies knowledge of business processes to identify opportunities for simplification and efficiencies

• Supports the enhancement of quality service and ensures effective and efficient operations support is in place for the assigned area's internal business partners and external clients

• Collaborates with Change Managers, Technology, and other business partners to support system enhancements and special projects

• Ensures adherence to procedures and regulatory requirements through updates and change training

Required Qualifications:

• Strong analytical, conceptual and problem solving skills – ability to drive root cause analysis, focus on details, identify issues, prioritize quickly and recommend solutions.

• Research analysis with the ability to gather, prepare and present  findings with business partners, as needed.

• Ability to balance multiple competing priorities in a fast-paced and complex environment.

• Intermediate level in various MS tools including Excel, PowerPoint, and SharePoint (a plus).

• Strong written & oral communication and presentation skills; able to target messaging to different audiences; provide consolidated data in a clear and concise manner.

• Minimum 2 years’ experience in high volume production operational environment.  

• Attention to detail & strong organizational skills.

• Able to prioritize daily work to meet deadlines and goals.

• Demonstrates a good working knowledge of processes and adherence to procedures.

• Capability to work effectively in a team environment & ability to multitask.

• Strong time management skills. 

Desired Qualifications:

• Prior experience working with and navigating various bank systems, Interact, Image view and outside Internet sources. 

• Willingly shares knowledge, expertise and best practices with others on the team. 

• 1-2 years of operational lead experience, a plus.

• AML or compliance based knowledge is an advantage for this role. (Enterprise Financial Crimes Standard, Consumer and Small Business AML Program, BSA and USA Patriot Act).

• Working knowledge of laws, rules, and regulations and ability to identify and escalate risk.

Skills:

• Adaptability

• Analytical Thinking

• Critical Thinking

• Data Collection and Entry

• Data Quality Management

• Collaboration

• Decision Making

• Interpret Relevant Laws, Rules, and Regulations

• Problem Solving

• Research Analysis

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