Job Description Quality Auditor would be responsible for the entire quality assurance process; from sample selection to conducting audits, performing error RCA and providing relevant feedback to associates.
Auditor would ensure correctness and completeness of cases and compliance with applicable regulatory requirements.
Auditor would also be responsible for reporting and tracking on accuracy SLAs and KPIs.
Conduct quality monitoring reviews to include documentation of processes and call scoring in relation to cases reviewed Assist in developing and implementing quality management programs and initiatives.
Complete RCA for all the critical errors identified.
Ensure that performance standards are measured and uniformly for the clinical review team.
Conduct coaching sessions with team in regards to improvements sessions that are needed.
Conduct quality assurance training as needed and facilitate or participate in weekly/monthly calibration sessions.
Escalate patterns of serious performance issues as necessary. Qualifications Has minimum of 1-2 years of experience dealing with customers, providers and /or members via the telephone.
Has a previous Quality Assurance and/or work experience.
Prior experience in Dental Practice Services is a plus.
Excellent verbal/written communication skills and presentation skills, including the ability to handle interactions with facility personnel, providers, members, and various internal departments in a professional manner.
Be a highly motivated individual that can work effectively, independently and meet deadlines in an atmosphere of multiple projects and shifting priorities.
Possess effective analytical/problem solving skills.
Ability to use PC-based word-processing, database, and spreadsheet• Possess extensive knowledge of medical terminology and anatomy.
Subject matter expert on all contracts maintained by Assessment unit.
Ability to speak English fluently is preferred