The Quality Department supervisor is responsible for coaching, mentoring, and training the Quality Department Auditors. The supervisor is accountable for identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team. Provides on-going feedback to the team and identifies areas for improvement and growth. Must be able to make independent decisions, prioritize workload effectively and collaborate with other internal departments to assist in meeting our corporate goals.
Primary Responsibilities
- Coordinate monthly audit schedule with customer service and claims management teams.
- Review and provide feedback on critical errors identified in Claims and Call Center audits.
- Address disputes regarding HIPAA, AUTO Fails, deductions, and claims errors.
- Assist QA staff with call and claims audit questions.
- Train new QA hires and lead call evaluation calibration sessions.
- Identify and address issues with agent calls, audio, or video.
- Perform Quality Review of calls and claims audits.
- Manage employee performance, including coaching and mentoring.
- Oversee payroll, timesheets, schedules, and time off requests.
- Foster a safe and productive work environment.
- Research and respond to escalated issues.
- Conduct daily team meetings with QA staff.
- Distribute and monitor auditor tasks.
- Document performance and disciplinary matters.
- Advanced knowledge of Microsoft Word and Excel
- Strong knowledge of contracts, medical terminology, and claims processing and procedures.
- Experience in call auditing or managed contact center team.
- 5+ years of payer industry experience.
- Excellent written and oral communication, interpersonal and negotiation skills with a demonstrated ability to prioritize tasks as required.
- Problem solving and critical thinking skills.
- Organizational skills, ability to effectively prioritize and multitask.
- Ability to establish and maintain positive and effective work relationships with clients, coworkers, members, providers, and customers.
- Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
- Bachelor’s Degree preferred or comparable experience in the healthcare field.
- Experience in managing union staff under CBA is preferred.
About
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.
Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.
Come be a part of the Brightest Ideas in Healthcare™.
Company Mission
Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.
Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
Annual Salary Range: $70,000-$73,000
The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity.
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected]
Skills Required
- 5+ years of payer industry experience
- Bachelor's Degree preferred or comparable experience in the healthcare field
- Advanced knowledge of Microsoft Word and Excel
- Strong knowledge of contracts, medical terminology, and claims processing
- Experience in call auditing or managed contact center team
What We Do
Brighton Health Plan Solutions (BHPS) is a health care enablement company that is transforming the way health care is accessed and delivered. Our innovative, customizable, sustainable solutions encourage patient activation and improve the quality of care — all at lower cost. We effect impactful change for self-funded plan sponsors, health systems, and TPAs through our extensive health care expertise: •Decades of health plan design and health plan management experience •Proprietary MagnaCare, Create®, and Casualty provider networks •Strong provider relationships •Cutting-edge, white-labeled technology platform that enhances the experience for providers, plan purchasers and health care consumers
