Quality Assurance Team Lead

Job description

Job Title: Team Lead, Quality Assurance

The Team Lead for Quality Assurance is responsible for guiding the quality team, fostering collaboration, and driving process improvement results. They provide day-to-day supervision and leadership of QA Analysts, indirect oversight of DRE quality performance, provide coaching, mentoring, and quality calibration leadership and communicate clear instructions and direction to help the team to achieve program goals. Responsibilities include setting performance goals, providing feedback and coaching, and resolving issues within the team.

Key Responsibilities:
People: Provide day-to-day leadership and management of the team, including feedback, quality audits, and inspiring the team. Perform basic supervisory HR tasks for employees (e.g., timesheets, performance reviews). Provide structured, documented feedback to DREs and QA Analysts. Develop individualized improvement plans for staff below performance thresholds. Monitor productivity, accuracy, and timeliness metrics. Partner with Operations Leadership and HR on performance management matters. Support onboarding and training for new hires.

Operations: Lead the development and execution of QA audit plans for IDRE eligibility determinations and payment determinations. Conduct targeted and routine audits (e.g., random sampling, every 10th case, high-dollar cases, complex disputes). Validate compliance with: Federal IDR regulatory requirements, CMS guidance and technical instructions, Internal SOPs and workflow documentation, Determination timeliness standards, Track and trend audit findings, root causes, and corrective action plans, Maintain audit scorecards and quality dashboards. Update and maintain QA policies, audit tools, and scorecards. Ensure alignment between SOPs and regulatory requirements. Lead cross-functional process improvement initiatives. Collaborate with Legal, Compliance, and Operations on interpretation questions. Support system enhancement validation against department and program needs.

What Success Looks Like:
- Guide the team through change management and operational growth
- Ensure quality of work
- Reach production goals
- Manage team members and their schedules
- Report key metrics to leadership
- Assist the Quality Assurance Manager with special projects
- Facilitate cross-team learning and training.
Required Skills:
- Outcomes-driven and Problem-solver with operational discipline
- Ability to jump between leadership and operational roles
- A solution-oriented mindset.

Servant Leader and People-Centered Leader: High people skills, ability to lead through others, deliver feedback effectively, hold yourself, teams and people accountable, and create an inclusive environment.

Technical Skills: Proficiency in MS Office with a focus on proficiency in Excel (pivot tables, conditional formatting, data validations, and basic statistical calculations). Excellent written and verbal communication.

Required Experience:
* 1+ years of demonstrated experience leading a team.
* 2+ years of experience regulatory compliance, audit, dispute resolution, or health plan operations.
* Bachelor's Degree or equivalent experience preferred in healthcare administration or related field preferred.

EEO Statement:
Provider Resources, LLC is an Equal Opportunity Employer. We do not discriminate against qualified applicants based upon any protected group status, including but not limited to race, religion, color, creed, sex (including breastfeeding and related conditions), gender identity/gender expression, pregnancy (including childbirth and related conditions), national origin, ancestry, age, marital status, military or veteran status, sexual orientation, genetic information, physical or mental disability or medical condition as defined by applicable equal opportunity laws. Any request for accommodation can be directed to Human Resources.

Benefits and Compensation:
Provider Resources provides a competitive benefits package that includes access to Medical, Dental, and Vision Insurance, Life Insurance, Disability, Health Savings Account (HSA), Flexible Spending Accounts (FSA), Critical Illness, Accident, Legal and ID Theft, 401k plan, PTO. The anticipated salary range for fully qualified candidates applying for this role will be [...] (not including discretionary bonus, equity, and benefits). The final salary offered will be dependent on several factors that include but are not limited to relevant previous experience including duration and type of experience within the industry, education, and internal equity.

HUBZone Preference: Preference will be given to individuals who reside in, or are willing to relocate to, a recognized HUBZone area. For more information, visit Go to www.sba.gov/hubzone for more information.