Bethesda, Maryland
Healthcare Quality Assurance Specialist Job Opening in Bethesda, Maryland - CareMetx is seeking ambitious, motivated individuals with excellent communication, interpersonal and organizational skills who would like the opportunity to help people navigate the difficult healthcare landscape using their healthcare administration or information technology patient's are prescribed high cost, specialty medications, organizations like CareMetx are hired by pharmaceutical companies to provide "hub services." This niche industry has fast become an integral player in getting specialty products and devices to the patients who need them by managing the reimbursement for those products, identifying alternative funding when insurer's don't pay and providing clinical services when necessary. The hub maintains communication with physicians, specialty pharmacies, payers and others to assure patients get their medications in a timely fashion and continue to track progress while they are taking the medication.
Quality Assurance Specialist
Description
POSITION SUMMARY:
Under the general supervision of the Supervisor and Manager, the Quality Assurance Specialist (QAS) will be responsible for monitoring and documenting program performance quality in support of departmental goals and initiatives. The QAS will evaluate both verbal and written interactions by program support staff and will work directly with the Program Manager and Quality Manager to design quality monitoring formats and quality standards. The QAS will fairly and consistently review the team interactions with both internal and external parties for accuracy and to support success in executing superior service and quality. The QAS will assist with the development and delivery of regular reports on performance, trends, and other actionable insights to the Operations Leadership team and Quality team.
PRIMARY DUTIES AND RESPONSIBILITIES:
Monitors performance quality of the program team and vendor partners
Monitors interactions and support request processing for accuracy of information, process/policy adherence, and call handling standards
Ensures that interactions and support requests are executed with a superior level of customer service
Documents evaluations utilizing departmental quality monitoring templates, established quality standards, and quality monitoring technology
Maintains and improve service quality by completing service, on the program, technical system, compliance, and process audits.
Participates in regular calibration meetings with QA, Training, and Operations Leadership to ensure consistency of expectations, standards, and evaluations
Proactively identifies trends based on quality evaluations and provide program Operations leadership with regular performance feedback
Updates job knowledge by studying trends in and developments in quality management; participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
Continuously researches new technologies and methodologies in contact center QA monitoring and presents this research.
Qualifications
EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
· Bachelor's degree or greater (education, general business, health sciences, managed healthcare, public policy or related disciplines are preferred)
· Knowledge of reimbursement and patient assistance programs:
· operational policies and processes
· A minimum of 3 years related work experience conducting quality in an inbound or outbound contact center environment
MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
1. Exceptional listening and analytical skills
2. Proficient in Word, Excel, and PowerPoint for presentation and report development
3. Strong knowledge of customer care processes and techniques
4. Excellent leadership, communication, and interpersonal skills
5. Flexible, detailed, and able to successfully adapt to change
6. Complies with all laws, regulations, and policies that govern the conduct of CareMetx activities related to the programs
7. Proven track record of meeting or exceeding goals and objectives
Preferred:
8. Experience developing quality monitoring formats and standards
9. Experience evaluating screen and voice recordings using a QA software or tool
10. Relevant experience with biologics
11. Previous experience in other functions within the pharmaceutical, biotech or related industry is preferred, e.g., case management, customer service & operations, etc.
Job Type: Full-time
Job Location:
Bethesda, MD
Required education:
High school or equivalent
Required experience:
experience in other functions within the pharmaceutical, Reimbursement HUB or related industry is preferred, e.g., case management, customer service and operations, etc.: 3 years
conducting quality in an inbound or outbound contact center environment: 3 years
relevant experience with spcecialty drugs: 3 years
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