Job Description

Summary

 

The Quality Analyst – Enrollment position role is primarily responsible for conducting daily, monthly, and quarterly auditing within the Leon Health, Inc. Enrollment Department. You will be responsible for conducting daily second level reviews of work pertaining, but not limited to, the processing of enrollments, disenrollments (involuntary/voluntary), cancellations, late enrollment penalty investigations, and Part D premium/LEP billing. You will also be responsible for conducting monthly end-to-end spot audits in each of the aforementioned areas. The Quality Analyst role will also assist with the designing, developing, and implementation of training and quick reference guides within the Enrollment Department, and will assist with ad-hoc and scheduled classroom and virtual training. Lastly, the Quality Analyst will assist management with regularly reviewing CMS-mandated reporting to ensure adherence with CMS reporting requirements.

 

Essential Duties and Responsibilities

  • Provide ad-hoc training and guidance to enrollment staff driven by quality audit results
  • Facilitate formal training sessions in both a face-to-face and virtual training environment
  • Conduct daily second level reviews on the following type of work (including, but not limited to): Enrollment processing, plan change processing, disenrollment (involuntary and voluntary), cancelation processing (voluntary), late enrollment penalty (LEP) processing, Part D premium/LEP processing
  • Conduct second level reviews of enrollment data validation (EDV) submissions
  • Conduct second level reviews of retroactive processing contractor (RPC) submissions
  • Assist with reviewing daily MARx batch files for potential discrepancies
  • Complete monthly universe end-to-end spot audits for the following areas (including, but not limited to): enrollment, disenrollment, cancelations, late enrollment penalty, premium and LEP billing
  • Participate in regular QA calibration sessions with enrollment department staff and management
  • Report trends to leadership identified through the completion of enrollment department quality audits
  • Assess additional training needs and identify and report opportunities for additional training resources and resources to leadership
  • Design, develop, and implement new training to address the learning needs of the department
  • Assist with the coordination and facilitation of new-hire and continuous training
  • Design and develop new quick reference guides and just-in-time communications to staff
  • Serve as a subject-matter expert for direct reports
  • Collaborate with leadership to identify coaching and training opportunities
  • Communicate time-sensitive information to staff through a variety of mediums, such as SharePoint, acknowledgment management system, e-mail, and huddles
  • Regularly QA Part C/D Enrollment/Disenrollment reporting for any discrepancies and collaborate with management and Plan vendors to make modifications, as needed, to ensure compliance with yearly CMS reporting standards
  • Assist staff with resolving escalated member calls pertaining to enrollment
  • Assess department adherence to all federal, state, and organizational regulations and policies and procedures pertinent Medicare Advantage enrollment operations
  • Assist with the designing, development, and implementation of quality assurance initiatives
  • Collaborate with subject matter experts within the organization to address escalated member inquiries and issues pertaining to enrollment

 

Required qualifications:

 

  • Fully bilingual in Spanish and English. Must be able to read, write, and speak in English and Spanish. Should have a strong grasp of insurance terminology in both Spanish and English
  • At least 2+ years of health insurance experience working in an Enrollment/Membership Department role
  • Intermediate knowledge of Microsoft Word, Excel and PowerPoint
  • Intermediate knowledge of SharePoint or similar intranet platforms
  • At least 2+ years’ experience with analyzing and interpreting data to provide relevant insights
  • Excellent written and oral communication skills
  • Ability to maintain accuracy and production standards
  • Strong analytical skills focusing on accuracy and attention to detail
  • Associate’s degree in related field or equivalent experience

 

Preferred qualifications:

 

  • 1+ years of experience in a quality assurance role
  • 1+ years of experience in a workplace learning role, including experience with facilitating virtual and face-to-face learning sessions and authoring workplace learning materials
  • Advanced knowledge of Microsoft Word, Excel and PowerPoint
  • Experience working with eKMS and/or LMS applications