Essential Duties and Responsibilities:
- Drive a data culture, operate as a site data expert/champion
- Use data to select and drive initiatives and improvements
- Analyze, measure, interpret and deliver site level performance data to Operations.
- Collaborate with cross-functional partners to develop initiatives to improve site performance
- Identify and work to resolve content and/or process discrepancies; identify additional training needs and present to internal partners.
- Build relationships with and collaborate with other subject matter experts; possibly including the customer; content developers; and policy experts.
- Support the Contact Center by staying up to date with processes and initiatives
- Ensure CSRs have what they need to provide world class customer service
- Be present be available, proactive and responsive, act as a voice to/of the CSR
- Possess familiarity and understanding of CMS processes, methodology, and applicable content
- Other duties as assigned
- Review and analyze medical records and health plan documentation to identify issue/concern
- Review determination letters to identify both low level and high-level errors and ensure well documented and accurate outcomes
- Communicate findings with Management, Appeals Officers, Preliminary Review Department and/or Administrative Team
- Maintains knowledge of rules and regulations, policies, procedures, and specific client requirements
- Bachelor's degree in relevant field of study and 5+ years of relevant professional experience required, or equivalent combination of education and experience.