QA Analyst, Member Experience Job in Solon, Ohio US
QA Analyst, Member Experience
The purpose of this position is to establish a planned, systematic approach of quality assurance to identify key functional and regulatory weaknesses in all areas impacting member experience and the Medicare Star Ratings program and provide recommendations for efficient and sustainable solutions. The Quality Assurance Analyst reviews and analyzes data and documentation, and is responsible for a variety of ad hoc assignments and reports. This position relies on extensive experience and judgment to plan and accomplish goals. This position may lead and direct the work of others, and a wide degree of creativity and latitude is expected. 1. Facilitate the development and implementation of star rating improvement initiatives. 2. Perform quality review of operational department activities. 3. Help identify root cause and functional area deficiencies with Business Unit Owners. 4. Provide statistical analysis based on audit results for dissemination to management for use in identifying knowledge deficits and productivity issues. 5. Prepare, review, update and monitor Standard Operating Procedures, with input from Subject Matter Experts (SMEs), to ensure proper process documentation, as well as compliance with CMS regulations. 6. Serve as technical expert on quality assurance related matters advising management on principles and techniques of quality assurance. 7. Identify and effectively communicate to supervisor quality assurance issues and trends, and potential compliance risks. 8. Provide support for internal and external regulatory audits, reviews and site visits. 9. Review and familiarize self with Medicare operating materials, memorandums, and guidance to ensure regulatory compliance. 10. Perform other tasks as assigned.