TELECOMMUTE – Milwaukee, WI
QUALITY ASSURANCE ANALYST
Milwaukee, Wisconsin, United States
At DentaQuest, we believe that everyone should live life free of dental disease.
As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system ? from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.
Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone.
We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.
To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community.
That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.
The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay.
Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.
The Quality Assurance Analyst, Medicare plays a key role in the Quality Assurance (QA) department as the person analyzing the audit data.
This includes analyzing those results for identification of root cause of Medicare quality issues and trends in the data, as well as recommending service delivery improvements to enhance the experience of our Medicare members.
This role also reports the results of internal audits to internal and external constituents.
PRIMARY JOB RESPONSIBILITIES:
Create and conduct customized quality audits that test specific client concerns and requirements.
Analyze audit results and quality client reports to identify trends and communicate top issues and new issues to internal contact center partners and business constituents.
Identify root cause to issues, including analysis of systems, business rules, and claims processing rules, office reference manuals, and dental codes to identify any discrepancies.
Recommend internal corrective actions, track to closure and report progress.
Maintain department Quality Standards and ensure adherence to them.
Adhere to DentaQuest’s business policies.
Other duties as assigned.
Five years’ experience in Medicare Managed Care.
Two years’ experience as an Analyst, or equivalent combination.
Two years’ experience in Medicare regulations
Superior critical thinking, analytical and problem-solving skills.
Ability to summarize, prepare and communicate complex information.
Proficient in the use of MS Office, including but not limited to MS Excel and MS Word.
Creative independent thinking skills.
Strong attention to detail.
Ability to interface well with personnel at all levels.
Ability to multi-task and organize complex data.
Ability to work in a team environment as well as an individual contributor.
Excellent communication skills: interpersonal, written and verbal.
Ability to work overtime as needed or required to meet business needs.
Required to attend additional train…
Insurance , Medical & Health , Dental , Analyst