Quality Analyst - Ambulatory Ops - Fulltime - Days - Remote

GENERAL SUMMARY:

Under general supervision, utilizes quality management tools to provide support and directly monitor and assess processes and workflows to ensure staff maintain both quality and production measures. Provides ongoing reporting and feedback to Customer Service management regarding staff performance. Measures and implements efforts to maintain or increase the quality of work performed within Customer Service. Conducts random audits and quality checks to ensure member inquiries are handled professionally and processed in an appropriate manner. Coordinates and facilitates calibration sessions. Facilitates training for new hires and current staff regarding the audit process and departmental quality expectations. monitors contacts and cases as outlined in the department Quality Policy and Procedure Manual. The Quality Assurance Analyst must compile monitored data and participate in the coaching, training, and development of the department's agents. Must have a clear and working understanding of any Service Level Agreement and overall quality standards. The Quality Assurance Analyst must have the skills to interact with various levels of leadership, including strong customer service, conflict resolution, active listening, analytical, writing and computer skills. The Analyst must have the ability to compile reports and effectively communicate the resulting analysis to the management team.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Performs call monitoring (recorded and live) to ensure Customer Service specialists comply with the rules and regulations of the organization as well as CMS requirements.
• Monitors advocates using quality monitoring tools to ensure agents comply with all rules, regulations, and standards for departmental Customer Service standards.
• Provides coaching, just-in time feedback and oversight for employees and/or in collaboration with leaders based upon individual performance needs identified through quality audit trends and data collection.
• Compiles monitored data for use in monthly department-wide reports, team reports and advocate scorecards.
• Assists with the implementation of new and on-going training initiatives. Evaluates and monitors new staff while in training, assisting with handling calls in the most effective and efficient manner while ensuring the level of customer service is not negatively impacted.
• Maintains knowledge of changes to protocols, procedures, and government, HIPAA, or legal compliance requirements.
• Collaborates with suppliers of data and management team to understand, calibrate, and improve the accuracy of quality monitoring information and tools.
• Maintains knowledge of trends in Quality Monitoring tool. Develops and implements additional programs using technology to support those efforts.
• Reviews processes to identify systemic issues and partner with process owners to improve service. Participates in continuous improvement workshops and other forums aligned with quality assurance and improvement.
• Utilizes the quality monitoring technological system to compile and track performance at team and individual levels.
• Reviews and assesses all performance reporting data and identifies gaps in required reporting. Prepares and analyzes internal and external quality reports for leadership review.
• Acts as a liaison between support departments and the Training team regarding performance related issues, keeping open communication to identify additional support or training needs.
• Randomly monitors mystery shop inquiries (both written and verbal), and reports feedback to leadership regarding individual, sectional and departmental performance.
• Performs other related duties as assigned.