The Call Quality Professional 1 monitors and evaluates the quality of inbound and/or outbound customer service calls. Documents quality issues and performance measures. The Call Quality Professional 1 work assignments are often straightforward and of moderate complexity. Reviews documentation to assess that appropriate system entries have been thoroughly completed to mitigate risk associated with external audit reviews.
Responsible for driving accuracy and quality assurance, compliance to all established policies and procedures, and sound documentation for all activities. Serve as a subject matter expert and make process recommendations.
The Call Quality Professional 1 provides information to assist in the feedback and formal education process of individuals on the phone. May assist in the development of monitoring standards. May act as subject matter expert. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
Healthcare experience required
Auditing experience required
Ability to handle multiple tasks and deadlines with strong attention to detail
Ability to analyze and proofread data
Research and analysis experience required
Ability to challenge incomplete or inappropriate case research and/or resolutions on grievances/ appeals
Ability to track and trend data and use findings to make recommendations
Excellent communication skills (both oral and written)
Proficiency in MS Office to include Excel, Word and Outlook
Medicare/Medicaid Grievance & Appeals experience
Bilingual English/Spanish with ability to speak read and write in both languages without limitations or assistance
Scheduled Weekly Hours