Quality Assurance Lead

3 weeks ago

Diamond Bar, United States Call the Car Full time
Job DescriptionJob Description

BASIC JOB PURPOSE:

To assist Quality Assurance (QA) Management to ensure daily tasks and responsibilities are being completed by the Quality Assurance (QA) Specialists. The QA Lead provides any training for the team and also monitors the productivity of the QA Specialists.


TYPICAL WORKING CONDITIONS:

Office environment. May require working under stress and tight deadlines. The position requires long periods of sitting.


WORKING SHIFTS:

Monday — Friday, 8-hour shift between the hours of 8:00am-4:30pm


RESPONSIBILITES/DUTIES:

• Review all systems throughout the day to ensure all cases are captured and assigned appropriately.

• Reviews completed complaints/grievances and any incident, accident, and injuries reported.

• Provides tools and training to address any gaps in knowledge, competency, and skills to Quality staff.

• Assist Grievance personnel in documenting, filing, tracking, and closing grievances.

• Ensure Grievance staff maintains compliance with all Department timeframes, documentation, and process per Call the Car (CTC) policy.

• Assist CTC management in the assessment of grievance information for potential changes to CTC policies and procedures.

• Creating and/or updating any Quality Assurance Desk Level Procedures that are needed.

• Completes quality review on all resolution letters and correspondence to members, providers and/or vendors for accuracy, quality, and proper documentation.

• Ensure appropriate grievance acknowledgement, resolution, and appeal letters are sent out within regulatory compliance and internal guidelines.

• Ensure grievance summaries and Corrective Action Plans (CAPs) are sent to contracted vendors and internal departments if needed and ensures that all CAPs are addressed.

• identifies trends and root cause of issues, propose solutions, or escalates ongoing issues to Quality Management team.

• Required to complete or process grievances/complaints of a complex nature or whenever assistance is needed.

• Monitors the entering of all grievances the same day received for each assigned day.

• Monitors the management of group email inboxes to ensure cases received are entered into the system correctly and in a timely manner.

• Monitors the researching, documenting, and closing of complaints and grievances.

• Researches and responds to any rebuttals including but not limited to vendor, client, or member of substantiated grievances and/or complaints.

• Measure and review daily productivity for QA Specialists.

• Provides training and onboarding orientation for new and/or existing Quality Assurance staff.

• Ensure all grievances/complaints are closed in the system daily.

• Any other duties as assigned by management.

PREFERRED QUALIFICATIONS:

• Ability to adapt to a changing environment and handle multiple priorities.

• Ability to work independently or with a team.

• Excellent problem solving, organization, multi-tasking, and time management skills.

• Experience and knowledge of Call the Car processes and systems including but not limited to CCERRTS, Medi Routes, dispatch, customer service, and client expectations.

REQUIREMENTS:

• 2+ years of relevant working experience in medical environment.

• 1-1.5-year(s) call center experience in a customer service setting preferred

• 2+ year(s) experience with complaints and/or grievance resolution in a medical environment

• Minimum high school diploma or GED required.

• Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook) required.

• Skilled using Google Docs and Drive, SharePoint, and Smartsheet preferred.

• Excellent problem solving, organization, multi-tasking, and time management skills.

• Effective written and verbal communication skills

• Must pass a Criminal Background Screening and a Drug Screen.

• Must pass government exclusion list at time of hire and monthly thereafter.


ACCOMMODATION: Call the Car has the right to modify the duties and functions of the job description based on the needs of the organization.

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