Summary of Position
Manage the day-to-day operations of the COB&R Quality Assurance (QA) Program and be the key resource for the QA team on quality assurance reviews. Ensure that QA reviews are properly assessed to relevant rules, regulations, policies, procedures and any other applicable guidelines. Ensure that the QA team conistently supports compliance responsibilities by completing QA reviews to assess accuracy and other quality performance factors on dalls handled by Customer Service Representatives, Recovery Specialists, CWF Analysts and otherwise required. Maintain privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance and adhering to applicable federal, state and local laws and regulations, COB&R and EmblemHealth's policies and procedures.
• Supervise and facilitate quality assurance program by ensuring all quality assurance reviews, including major components of the COB&R QA program which are performance review of customer calls, correspondence processing, data validation and EDI data file transmissions, are completed accurately and on a timely basis.
• Monitor, review and communicate to the QA Officer the QA team's on-going status towrds departmental goals.
• Perform QA reviews as needed to meet department goals.
• Support and develop the QA team in ahieving the QA Program objectives and goals.
• Provide guidance on performing quality reviews of BCRC processes.
• Prepare analysis schedules and worksheets to document and analyze quality assurance review results.
• Identify ineffective and problem events and perform trend analysis to systematically identify troubled areas and forecast performance levels.
• Interface with various departmental management teams to ensure that reference and review information sources are current and efective for the QA team.
• Communicate QA review results to management teams and trrack required actions to resolution.
• Assist the QA team in facilitating quality operations, cost efficiencies and process improvements to enhance the COB&R quality management system.
• Assist the QA team in identifying findings and recommendations to improve the QA Program and overall COB&R operations.
• Perform other related tasks as assigned.
Position Success Criteria
• Excellent organizational, analytical, verbal and written communication skills.
• Ability to work under pressure and meet stringent deadlines.
• Knowledge of the Coordination of Benefits and Medicare Secondary Payer Recovery Contractor concepts, HIMR, COB System and/or ReMAS a plus.
Education and Experience
• Bachelor’s degree.
• 5 years quality or operations review experience or equivalent and of which at least 2 year in a supervisory capacity.
• Working knowledge of Microsoft WORD and EXCEL skills.
This posting expires on 12/19/13.
EmblemHealth - 9 months ago
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EmblemHealth is set on being the mark of good health in the Northeast. The not-for-profit company provides health...