Quality Assurance Team Lead

Verida Inc•Villa Rica, GA

About The Position

This position is responsible for receiving, investigating, compiling, and reporting transportation complaints, as well as those related to Medicare Client Grievances for Centene and WellCare and training incoming team members.

Requirements

Knowledge of Medicare and Medicaid, community resources, dialysis, and the nursing home placement process.
Must possess entry to mid-level proficiency in Microsoft Word and Excel.
Excellent written and verbal communication skills.
Possesses and demonstrates multi-tasking skills in a high-stress environment while working with multiple internal departments, as well as external entities.
Analytical thinker with good judgment.
Well-organized, self-directed individual, who is flexible and takes direction well.
Possesses a high level of interpersonal skills to handle sensitive and confidential situations.
High School graduate or equivalent
Healthcare-related education
2 years of customer service experience and or employment in a paid healthcare-related work setting

Responsibilities

Reviewing Inquiries DCH North | DCH Atlanta
Closing Inquiries DCH North | DCH Atlanta
Reviewing Grievance for Medicare Clients: Centene and WellCare
Closing Grievances for Medicare Client: Centene and WellCare
Sending RFEs (Request for Explanation) to transportation providers
Sending Nursing Home Unassigned Trip Reports to Special Services and Dispatch Departments.
Monitoring Unassigned NH trips
Mastery of various applications: InSight, Provider Portal, Lyft Concierge, Verida.
Coverage of the Atlanta QA Voicemail Box
Assigning members to MCA (Member Care Advisory) List and updating this information via InSight
Sending Productivity Report at day’s end
MCA Trip Monitoring
MCA Documentation via trip notes, manifest notes, member main file notes
MCA Workflow
DCH Trip Monitoring and Reporting
Emailing MCA Same Day | MCA Next Day Reports