Senior Manager, Audit and Program Operations

United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Healthcare TechnologyIndustries

Requirements

Candidates should possess a Bachelor's degree or equivalent work experience, with over 6 years of experience in leading project-based work, identifying and resolving bottlenecks, and addressing root causes for process improvements. Strong skills in distilling and communicating complex problems, adaptability in a fast-paced environment, curiosity for learning, and the capacity to leverage analytics and critical thinking for rigorous insights are essential. Experience with SQL or similar data analysis tools, healthcare operations, Medicare, Risk Adjustment, HCC coding, and compliance with CMS, OIG, and HIPAA regulations are highly desirable.

Responsibilities

The Senior Manager, Audit and Program Operations will manage a portfolio of audit projects from initiation to results presentation, developing insightful reports for risk assessment, provider education, vendor management, and audit strategy. This role involves collaborating with engineering, product, data, and operational partners on cross-functional initiatives, serving as an expert on audit tooling and reporting, and driving continuous innovation for operational excellence. Additionally, the position is responsible for maintaining department policies, procedures, and oversight monitoring, leading a team of risk adjustment auditors, managing production, and ensuring quality outcomes.

Skills

Audit Management

Risk Adjustment

Reporting

Project Management

Team Leadership

Process Improvement

Cross-functional Collaboration

Policy Development

Procedure Development

Devoted Health

Medicare Advantage plans with personalized support

About Devoted Health

Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.

Waltham, MassachusettsHeadquarters

2017Year Founded

$2,194.5MTotal Funding

SERIES_ECompany Stage

HealthcareIndustries

1,001-5,000Employees

Benefits

Comprehensive health plan

401(k) retirement plan

Generous vacation and holiday time

Lyra mental health resources

Time off to vote

Risks

Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.

Potential regulatory changes affecting Medicare Advantage plans by CMS.

Rising healthcare costs could impact the affordability of Devoted Health's plans.

Differentiation

Devoted Health offers personalized assistance through Devoted Health Guides for member support.

The company emphasizes preventive care with its Devoted Dollars rewards program.

Devoted Health integrates virtual and in-home care with top local providers.

Upsides

Devoted Health raised $287 million in Series E funding in 2024.

The company expanded Medicare Advantage plans to eight new states in 2023.

Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.

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