Quality Assurance Team Lead

SUMMARY: This position is responsible for receiving, investigating, compiling, and reporting transportation complaints, as well as those related to Medicare Client Grievances for Centene and WellCare and training incoming team members.

ESSENTIAL FUNCTIONS

Quality Assurance Specialist: DCH Complaints and Medicare Grievances Role

• Reviewing Inquiries DCH North | DCH Atlanta
• Closing Inquiries DCH North | DCH Atlanta
• Reviewing Grievance for Medicare Clients: Centene and WellCare
• Closing Grievances for Medicare Client: Centene and WellCare
• Sending RFEs (Request for Explanation) to transportation providers
• Sending Nursing Home Unassigned Trip Reports to Special Services and Dispatch Departments.
• Monitoring Unassigned NH trips
• Mastery of various applications: InSight, Provider Portal, Lyft Concierge, Verida.
• Coverage of the Atlanta QA Voicemail Box
• Assigning members to MCA (Member Care Advisory) List and updating this information via InSight
• Sending Productivity Report at day's end

Quality Assurance Specialist: Member Care Advisor (MCA) Functions of QA Role

• MCA Trip Monitoring
• MCA Documentation via trip notes, manifest notes, member main file notes
• MCA Workflow
• DCH Trip Monitoring and Reporting
• Emailing MCA Same Day | MCA Next Day Reports

REQUIRED KNOWLEDGE AND SKILLS

• Knowledge of Medicare and Medicaid, community resources, dialysis, and the nursing home placement process.
• Must possess entry to mid-level proficiency in Microsoft Word and Excel.
• Excellent written and verbal communication skills.
• Possesses and demonstrates multi-tasking skills in a high-stress environment while working with multiple internal departments, as well as external entities.
• Analytical thinker with good judgment.
• Well-organized, self-directed individual, who is flexible and takes direction well.
• Possesses a high level of interpersonal skills to handle sensitive and confidential situations.

MINIMUM REQUIRED EDUCATION

• High School graduate or equivalent
• Healthcare-related education
• 2 years of customer service experience and or employment in a paid healthcare-related work setting