Quality Assurance Specialist Resume Example
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- Process and determine initial eligibility for Medicaid.
- Determine initial and continued eligibility for state medical assistance programs.
- Completing full investigations on cases that have been appealed and working directly with DMAS (The Department of Medical Assistance Services) to ensure the appropriate decisions are made on each case.
- Present the appeals summary during the appeal hearings.
- Gather information, collects data, and evaluate information for accuracy and consistency.
- Process applications and determine eligibility and benefit levels using VaCMS (Virginia Case Management System) and MMIS (Medicaid Management Information System).
- Lead implementation team to improve the efficiency and effectiveness of the projects we support with focus driving revenue.
- Focus on driving a knowledge of the material for Medicare Responsible for development of training material Lead training classes for new hires to expand the knowledge of Medicare and claims and existing members on current and new best practices.
- Assist in job interviews and hiring process.
- Responsible for developing, training, and implementation of the Customer Service Representatives.
- Review recorded calls through systems such as Avoke, Mattersight, Behavior Analytics, and Verint to ensure quality and accuracy.
- Develop plan of action on reoccurring issues Provide direction to the training team for the ongoing maintenance and prioritization of training programs and tools.
- Worked with Supervisors to improve the efficiency and effectiveness of the request of providing excellent customer service.
- Travel to different sites across the U.S.
- to assist with the startup of the MarketPlace contract.
- Manage internal and external teams.
- Utilizes reporting tools to measure and communicate progress, quality, and compliance to the program.
- Responsible for annual performance reviews for Customer Service Representatives.
Account Management, Active Learning,Client Relations, Computer Proficiency, Coordination, Creative Problem Solving, Critical Thinking, Customer Needs Assessment, Customer Service, Data Collection, Data Entry, Documentation, Email, Executive Management Support, Filing, Grammar, Internet Research, Report Transcription, Research, Scheduling, Service Orientation, Speaking, Spreadsheets, Telephone Skills, Time Management, Travel Arrangements, Travel Booking, Travel Planning, Type 40 WPM, Typing, Writing, Letters and Memos, Microsoft Excel, Microsoft Office Suite, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word, Multi-Task Management, Organizational Skills, Prioritization, Proofreading, Reading Comprehension
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Resume Overview
School Attended
- John Tyler Community College
Job Titles Held:
- Quality Assurance Specialist
- Quality Specialist
- Training Specialist
- Supervisor
Degrees
- Nursing
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