Compliance and Quality Assurance Supervisor

Tempus Unlimited Inc•Stoughton, MA

7d•Onsite

About The Position

The Compliance and Quality Assurance Supervisor is responsible for supervising all activities and personnel associated with performing tasks and work processes assigned to the group. Actively participate as a member of the department management team and the larger organization in support of business objectives. Essential Job Functions Fraud Oversight Oversee the review and documentation of potential fraud, waste, and abuse concerns.Ensure cases are tracked, reviewed, and closed within required timeframes. Assist with gathering information for reports or follow-up requests from internal teams or external agencies. Identify patterns and bring forward trends or issues for review. Handle the research of PA and MA Grievances Inboxes, providing information to Compliance Manager. Coordinate the MA Grievance Semi Annual spreadsheets for submission to MassHealth (Jan and July). Develop, measure, and report meaningful key metrics. Identify, design, and implement process improvements. Records Request Management Supervise processing of records, medical records, subpoenas, authorizations, and general information requests. Make sure requests are handled accurately, securely, and within required turnaround times.Serve as the escalation point for complex or urgent requests. Maintain tracking logs and ensure proper documentation. Supervisory Responsibilities Provide daily supervision, coaching, and guidance to assigned staff.Assign and monitor workload to ensure service standards are met. Support training, onboarding, and ongoing development or team members. Conduct performance reviews and support corrective action when needed. Coordinate with other functions in payroll & billing to streamline workflows/handoffs. Lead department meetings. Supporting other department functions as necessary. Perform other duties as assigned. Compliance & Reporting Maintain organized documentation to support audits and internal reviews. Prepare regular reports on fraud cases, record requests, and FI activity. Assist with internal compliance projects and workflow improvements. Participate in internal reviews, privacy matters, and follow-up actions as needed. Other Support overall mission and objectives of Tempus Unlimited Must report all suspected incidents of consumer sexual abuse, physical abuse and neglect to the Disabled Person Protection Commission (D.P.P.C.).

Requirements

Ability to supervise and direct staff
Excellent organizational skills
Attention to accuracy and detail
Strong interpersonal skills – telephone skills
Excellent oral and written communication
Good computer and analytical skills
Innovative thinking
High School Diploma
Experience working with confidential information.
Strong attention to detail and accuracy.
Ability to communicate clearly and professionally.
Basic proficiency with Microsoft Office (Word, Excel, Outlook).

Nice To Haves

Familiarity with Fraud functions & PCA program procedures and regulations
Ability to maintain confidentiality

Responsibilities

Oversee the review and documentation of potential fraud, waste, and abuse concerns.
Ensure cases are tracked, reviewed, and closed within required timeframes.
Assist with gathering information for reports or follow-up requests from internal teams or external agencies.
Identify patterns and bring forward trends or issues for review.
Handle the research of PA and MA Grievances Inboxes, providing information to Compliance Manager.
Coordinate the MA Grievance Semi Annual spreadsheets for submission to MassHealth (Jan and July).
Develop, measure, and report meaningful key metrics.
Identify, design, and implement process improvements.
Supervise processing of records, medical records, subpoenas, authorizations, and general information requests.
Make sure requests are handled accurately, securely, and within required turnaround times.
Serve as the escalation point for complex or urgent requests.
Maintain tracking logs and ensure proper documentation.
Provide daily supervision, coaching, and guidance to assigned staff.
Assign and monitor workload to ensure service standards are met.
Support training, onboarding, and ongoing development or team members.
Conduct performance reviews and support corrective action when needed.
Coordinate with other functions in payroll & billing to streamline workflows/handoffs.
Lead department meetings.
Supporting other department functions as necessary.
Perform other duties as assigned.
Maintain organized documentation to support audits and internal reviews.
Prepare regular reports on fraud cases, record requests, and FI activity.
Assist with internal compliance projects and workflow improvements.
Participate in internal reviews, privacy matters, and follow-up actions as needed.
Support overall mission and objectives of Tempus Unlimited
Must report all suspected incidents of consumer sexual abuse, physical abuse and neglect to the Disabled Person Protection Commission (D.P.P.C.).