Medicare Non-Call QA Analyst | Quality & Compliance

Convey Health Solutions is a BPO serving several Medicare Healthcare companies. At Convey Health Solutions, we're experts in highly-compliant member enrollment, service and administration support (Medicare, Medicaid and Commercial / EGWP). For over a decade, we've managed very large-scale end-to-end health insurance processes for our business clients - from eligibility and enrollment processing to service, premium billing and payment processing, reconciliation and other related services. Job Description The QA Analyst NC will provide the highest level of support to ensure that Convey Health Solutions Non Call Operations quality and performance improvement goals are met through process auditing.Under the guidance and direction of the Non Call QA Supervisor and/or Manager, the QA Analyst NC is expected to demonstrate knowledge of all department systems, e.g. Convey Health Solutions 1) Medicare Service Platform, 2) External Client RX Claims System, Non Call QA Automated System, in addition to CMS’s database system. This position is responsible for monitoring all Non-Call transactions ensuring accurate processing of all transactions as well as adherence to CMS regulatory requirements if required. The incumbent will ensure that we are providing a superior level of service to our internal and external clients in an environment that is empowering, creative and constantly improving. Responsible for compliance with all federal, state and local laws, rules and regulations affecting Company. Responsible for participating in quality assurance, compliance and in-service and continuing education activities as requested by Company. Responsible for performing other duties and responsibilities as required. Ability to review Standard Operating Procedures, Policy & Procedures, Job Aids, Process Flows and interpret its purpose.a. Policy & Procedures - how an entity will function and be administered.Standard Operating Procedures - established or prescribed methods to be followed routinely for the performance of designated operations or in designated situations. Job Aid – Tool that allows an individual to quickly access the information he or she needs to perform a task. Process Flow – Tool to use to visually document the stages involved in performing a certain procedure. Ability to take the above tools and apply it to functions/actions being performed in a members account. Capacity to not only ensure that the agents/analysts/specialist are performing their tasks according to above tools (to specifications), but to identify when a function/action was performed that is not included in the documentation available. Understand how to research an account, look in all screens available to interpret function/actions taken. Ability to review and understand the CMS guidelines and how they correlate to the internal processes. Understand what and when an exhibit should be triggered. Understand how Medicare Service Platform disposition affect account status, trigger events, queue activities. If not clearly defined in tools above, reach out to Operations leadership to provide. Understand timelines for exhibits triggers, status changes, system activity, etc. Capability to develop writing skills to be clear, simple and to the point. Qualifications Education and Experience – Required education, training, licenses, accreditation or certification and number of years and type of directly related experience. If applicable, please identify if an alternate “equivalency” of a combination of education and experience is sufficient. Degree High School Preferred major/area of study N/ANumber of years of supervisory/management experience (if any) Number of years of experience 1 - 2 in Quality Assurance and/or Medicare Advantage Plans. Type of experience – Requires:Strong organizational & time management skills with the ability to assist with workflow planning. Have a high standard of workmanship and a keen eye for detail.• Computer and data entry proficiency.• In-depth, hands-on knowledge of Microsoft Office suite, particularly Word, Excel, Access & PowerPoint. Intermediate knowledge of Medicare regulations and processes is required. Must have excellent oral and written skills. Additional Information All your information will be kept confidential according to EEO guidelines. By clicking the link above or any third-party link within this posting, you are leaving this site and going to a third-party website where the third-party website's terms and privacy policy apply #J-18808-Ljbffr Convey Health Solutions