Quality Assurance Specialist

New England Sinai Hospital And Rehabilitation Center Phoenix , AZ 85002

Posted 2 weeks ago

The primary role of this position is to develop and follow Quality Monitoring Guidelines to provide a detailed description of the call quality performance requirements.# This role will be responsible to monitor and evaluate all lines of Call Center Operations business as well as monitor and evaluate calls for other departments taking calls from both members and/or providers. Oversee day to day operations set forth by the Department Management: Call Center Operations is committed to the delivery of quality services to its members and providers through the telephone system.# Monitoring of all phone representatives for all lines of business a minimum of 3 calls per month (may vary depending on line of business) ensuring adherence to contractual and Health Choice guidelines, and facilitate cross-training for increased responsiveness and departmental efficiency Complete electronic monitor forms on each call, record and communicate monitor results to phone representative Report results to management team Partner with department trainers to enhance training materials and develop ongoing training pertaining to quality assurance Review and access usage of correct action codes, and appropriate documentation in delivery systems (MedMC, Care Radius etc) Meet with Department Management on a regular basis to assess departmental operation and activities Complete and deliver any quality reports to the respective lines of business Ensure confidentiality and not release any information except to persons authorized by Health Choice or as required by law (URAC, v7.1, CORE 16b). Conduct #spot# monitoring on an as needed basis Conduct #side by side# monitoring on an as needed basis Any other activities as directed by department Leadership # #

############ Proper customer service technique

Microsoft office

; Word, Excel Prefer Bilingual in Spanish


Bilingual (English and Spanish) preferred Computer experience necessary Effective time management and organizational skills Effective interpersonal and communication skills Use of a multi-line phone


################# Ability to handle upset members Able to handle fast paced high stress situations Complete tasks with little supervision Ability to lead others Ability to think analytically and make independent decisions Ability to manage large workload Ability to maintain a positive work environment for employees Ability to maintain positive work relationships Handle multiple and changing priorities at a fast pace Work cooperatively, positively, and collaboratively in an interdisciplinary team Work respectfully and positively with members and providers Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames


High School Diploma or G.E.D. preferred Some college preferred in business or health care desired Experience: At least two (2) years customer service experience At least two (2) years Medicaid and Medicare experience, preferably AHCCCS. At least one (1) year call center environment preferred At least one (1) year experience as a trainer preferred

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Quality Assurance Specialist

New England Sinai Hospital And Rehabilitation Center