Case Management Quality Control Analyst

TrialCard•Morrisville, NC

29d•Onsite

About The Position

The Case Management Quality Control Analyst is responsible for reviewing and evaluating the performance of the Program Representatives as they complete their cases and represent Mercalis Market Access and our clients to patients, providers, and pharmacies. This position requires the ability to work in a constructive, impartial, and collaborative manner by establishing positive work relationships, partnering with the Market Access Leadership team, Training, and Client base. This position requires the ability to gain the confidence and trust of others by demonstrating professionalism and expertise in an ever-changing environment.

Requirements

High School Diploma or equivalent required
Minimum of 2 years of QA/QC audit experience required
2-3 years of customer service, reimbursement/insurance, healthcare billing, physician office or health insurance processing experience required
Intermediate knowledge of FDA regulations of AE/PC and HIPAA guidelines
Must be a motivated self-starter with the ability to work independently and cooperatively within a cross functional environment
Must be able to manage priorities while working independently without direct supervision and be able to direct and manage the work of others with a high level of professionalism and integrity
Must be flexible and have the willingness and ability to respond to changing circumstances and expectations readily punctuality and reliability
Must be able to problem solve and make independent decisions with high level of confidence
Must be able to collect, gather, visualize, and analyze data in detail.
Ability to be fair and impartial
Display a high level of professionalism, integrity, maturity, and maintain a positive attitude
Excellent verbal and written communication and interpersonal skills
Strong planning, time management, attention to detail and organizational skills
Comfortable interacting with all levels of management and personalities
Basic knowledge in MS Office (Word, Excel)

Nice To Haves

Basic knowledge of monitoring software preferred (i.e. Zoom Call Recording, Calabrio, NICE Call Recording, etc.)
Prefer candidates who can type at least 35 words per minute with 97% accuracy.
Although very minimal, flexibility to travel as needed is preferred.

Responsibilities

Reviews and evaluates the performance of all representatives using an approved quality scorecard in the areas of patient experience, Federal and Drug Administration (FDA) regulations of Adverse Events (AE)/Product Complaints (PC) and Health Insurance Portability and Accountability Act (HIPAA) compliance, and specific program policies and procedures
Analyzes potential call trends through call monitoring and works with the internal departments to develop solutions to improve the patient experience
Maintains a thorough understanding of company Standard Operating Procedures (SOPs), process and policy requirements
Prepares and analyzes internal quality reports for management staff to review
Manages disputes and call requests received through ServiceNow portal.
Participates and/or facilitates internal and external calibrations to identify Client’s needs and expectations
Facilitates new hire training and introduces program quality standards and expectations
Prepares call records and/or corresponding documents and participates in internal and external client audit.
Handles requests to locate specific call records from the call recording system and provides reports of findings, and edit call recordings to remove Protected Health Information as requested or according to contractual agreements
Participates in internal department meetings as needed
Contributes to the design of call monitoring formats and Quality standards
Identifies and reports pharmacovigilance information as required by client(s) (i.e., Adverse Events)
On time adherence to training deadlines for all corporate policies and procedures governing access to confidential data
Ensure all SOPs are followed with consistency
Conducts miscellaneous tasks or projects as assigned

Benefits

Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
Additional health support, including telehealth and Employee Assistance Program (EAP) services
Company match on Health Savings Account contributions
Free Basic Life and AD&D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
Paid Time Off (PTO) and Sick Leave to support work-life balance
Team members receive nine paid holidays plus two floating holidays
Opportunities for advancement in a company that supports personal and professional growth
A challenging, stimulating work environment that encourages new ideas
Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
A mission-driven, inclusive culture where your work makes a meaningful impact