Experience

Western Health Advantage

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Quality Assurance Specialist

  • Aug 2017 - Present

• Premuim Billing Supervisor

  • Jun 2015 - Present

• Quality Assurance

  • Dec 2013 - Jun 2015

  • Responsible for completing 35 audits per MSR per month. Audits consist of live and recorded calls.• Responsible for completing 7 case audits for each Member Relations Representative per month.• Responsible for completing quarterly audits for Medical Management of • Responsible for completing both Pharmacy and Benefit information audits for Member Services.• Responsible for completing various daily and monthly reports using Access Database, Rubi, Taske and Excel.• Complete monthly audit packets for both the Member Service and Member Relations Department• Responsible for conducting New Hire training. • Provide coaching, mentoring and on-going training for new hire staff.• Take inbound Spanish calls when needed. Show less

• Call Center Supervisor

  • Apr 2011 - Dec 2013

  • Monitor call volume. • Assist in answering inbound calls when call volume was high• Monitor the MSR’s log in/out times and for adherence to breaks/lunch schedule.• Daily attendance for Member Service and Member Relations• Answer benefit/claim/eligibility questions from the MSR’s.• Complete claim/member billing and pharmacy related cases MSR’s can-not resolve• Resolve internal and external escalations from Employer groups, Medical Groups, Brokers, Providers and Members• Review and submit timesheets in to HR. • Report any Facets Issues.• Conduct 10 audits and complete Call Evaluation summary for each MSR• Complete monthly MSR Case Count Report and Call Stats summaries.• Review/forward/reply to emails sent to the Member Service Inbox• Complete ID Card Error Report • Conduct new hire training as needed Show less