Internal QA/QC Specialist

SCOPE OF POSITION: 
As a member of the Outreach Quality Assurance, Quality Control (QA/QC) team the Quality Assurance, Quality Control Specialist is involved in one or more areas of Outreach requirements; including but not limited to AFMC Outreach and Provider Outreach activities. Responsible for the quality review of inbound and/or outbound telephone and email inquiries of outreach representatives to ensure accurate information is provided professionally, courteously, and consistently. Audits phone conversations for compliance with corporate policies, procedures, and applicable regulatory guidelines. Responsible for the quality review of documents to ensure accurate information is provided to external customers. Support the organization’s mission, vision, and values by exhibiting the following behaviors: Honesty, Excellence, Accountability, Respect and Teamwork  

ESSENTIAL JOB FUNCTIONS:

1. Conduct quality reviews of telephone representatives' performance within functionally specific units to ensure quality service goals and standards are met and/or identify areas where improvement can be achieved.
2. Audits representatives' inbound and outbound phone calls and/or correspondence, observing performance, techniques, and application of guidelines and procedures.
3. Verifies that representatives are providing up-to-date information, following current processes, and communicating effectively to callers.
4. Coordinates with department manager or supervisor to ensure appropriate number of audits are performed for each phone representative and to ensure representatives' availability during audit periods.
5. Evaluates and records the quality and performance during each call.
6. Reviews and verifies document records to ensure documentation complies with organizational policies, contractual obligations and state and federal laws. 
7. Provide creative solutions for reviewing data and solving problems identified. 
8. Summarizes findings and recommendations and forwards to Supervisor to use in performance assessments and promotional decisions.
9. Provides feedback on application of guidelines and procedures.
10. Provides critical data used to generate weekly or monthly reports on the performance of phone or email representatives.
11. Identifies adverse performance trends and patterns.
12. Provides input and assists with the development of additional training or policy and procedure changes that may be required to enhance service productivity.
13. Provides coaching, advice and guidance based on audit findings, and delivers performance feedback to associates as outlined in business unit's policies and procedures.
14. Mentors newly hired representatives to ensure a smooth transition from learning environment to daily work environment and may participate in providing formal training.
15. Participates in meetings and presentations or other designated special projects as assigned by department manager.
16. Maintains a comprehensive working knowledge of policies, procedure, and benefits across all service lines.
17. Other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Intermediate level computer skills (Excel, Word, Power Point and Outlook)
• Type 50 wpm
• Exceptional skills in business English and spelling are required.
• Ability to maintain confidentiality.
• Strong oral and written communication skills.
• Creativity.
• Customer service.
• Ability to meet deadlines.
• Attention to detail.
• Flexibility.
• Medical terminology.
• Ability to work collaboratively and independently to achieve stated goals.
• Initiative.
• Ability to relate professionally and positively with staff, business partners, customers, constituents, recipients, and the public.
• Ability to multitask.
• Ability to prioritize.
• Strong organizational skills.
• Problem solving skills.
• Professionalism.
• Project management skills.
• Ability to read, interpret and apply laws, rules, and regulations.
• Knowledge of quality improvement processes and techniques.
• Time management skills.
• Bilingual a plus.
   

Physical and Sensory Requirements (With or Without the Aid of Mechanical Devices):
Mobility, reaching, bending, lifting, grasping, ability to read and write, ability to communicate with personnel, ability to remain calm under stress and ability to travel as needed. Must be able to lift and transport 25 pounds. Must be capable of performing the essential job functions of this job, with or without reasonable accommodations. Position requires ability to work in an office environment with the flexibility to work remotely, potentially travel throughout the state, with occasional overnight stays, and manage the stress of meeting multiple deadlines and handling interruptions to on-going work activities. 

EDUCATION:
Required: Bachelor’s degree in health sciences field, business, or related field  

EXPERIENCE:
Required: Three (3) years of professional customer service experience, preferably in quality assurance/control, and an understanding of the Medicaid Guidelines.
Desirable: Have functioned in a healthcare setting.

INTERNET REQUIREMENTS:
Reliable, high-speed wireless internet service (Wi-Fi)
An upload speed of at least 2Mbps is required to support softphone functionality