Sr Specialist - QA
Description & Requirements
Maximus is currently hiring for a Sr Specialist - QA to join our State East team.
This is a remote opportunity.
The Sr.
Specialist - QA is responsible for reviewing cases, providing feedback to appeals officers, and making corrections as needed within the required deadlines.
Essential Duties and Responsibilities:
- Drive a data culture, operate as a site data expert/champion
- Use data to select and drive initiatives and improvements
- Analyze, measure, interpret and deliver site level performance data to Operations.
- Collaborate with cross-functional partners to develop initiatives to improve site performance
- Identify and work to resolve content and/or process discrepancies; identify additional training needs and present to internal partners.
- Build relationships with and collaborate with other subject matter experts; possibly including the customer; content developers; and policy experts.
- Support the Contact Center by staying up to date with processes and initiatives
- Ensure CSRs have what they need to provide world class customer service
- Be present be available, proactive and responsive, act as a voice to/of the CSR
- Possess familiarity and understanding of CMS processes, methodology, and applicable content
- Other duties as assigned
- Monitors and manages QC case load including standard and expedited cases to ensure timely submissions and meet client deadlines
- Review and analyze medical records and health plan documentation to identify issue/concern
- Review determination letters to identify both low level and high-level errors and ensure well documented and accurate outcomes
- Communicate findings with Management, Appeals Officers, Preliminary Review Department and/or Administrative Team
- Maintains knowledge of rules and regulations, policies, procedures, and specific client requirements
Minimum Requirements
- Bachelor's degree in relevant field of study and 5+ years of relevant professional experience required, or equivalent combination of education and experience.
- Ability to commit to a training schedule of 8am-5pm CST Monday - Friday required
- Ability to work occasional weekends as necessary required
- Technical writing and/or technical editing experience in a medical setting highly preferred
- Knowledge of medical terminology preferred
- Knowledge of medical appeals preferred
- Must be a self-starter
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates ofte...
- Rate: 60250
- Location: Baltimore, US-MD
- Type: Permanent
- Industry: Finance
- Recruiter: Maximus
- Contact: Not Specified
- Email: to view click here
- Reference: 25472_MD_Baltimore
- Posted: 2024-10-10 08:26:23 -
- View all Jobs from Maximus
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