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Position Details

  • Position: Medicare Call Quality Assurance Manager
  • Employment Type: Full-Time
  • Location: Allentown PA

Ideal Concepts, Inc. is looking for an experienced Medicare Call Quality Assurance Manager to lead and oversee the Medicare Call Quality Assurance team, monitor operations, and assist in setting and implementing Medicare compliance and Medicare call quality standards.

The Medicare Call Quality Assurance team audits our agent sales force and supports our Medicare Compliance Quality Assurance program by reviewing sales calls, identifying and documenting concerns and trends, and providing findings and feedback to Compliance Department leadership and sales management. This team is key to ensuring our agents’ compliance with company policies, carrier requirements, CMS regulations, and all other applicable federal and state laws. Our Medicare Call Quality Assurance team also researches client complaints and other external inquiries, settles lead disputes, and promotes our company’s goal of overall compliance. 

A strong candidate for this position has experience developing and managing timeline driven and detail-oriented staff with high volume output. A strong candidate also has proven analytical skills, is adaptable to change, driven to work independently, and can complete work consistently with a high level of accuracy in a fast-paced environment. 

Responsibilities and Duties

  • Lead, coach, train, and mentor the Medicare Call Quality Assurance staff.
  • Manage the Medicare Call Quality Assurance program, including the design, development, implementation, and oversight of associated policies and practices that ensure the organization complies with carrier, contractual, and regulatory requirements.
  • Serve as Subject Matter Expert for Medicare.
  • Ensure compliance with Ideal Concepts’ Standard Operating Procedures ("SOPs").
  • Assist in screening Compliance Quality Assurance Reviews and Compliance Quality Improvement Plans (“CQIPs”) prior to issuance, as needed.
  • Coordinate implementation of CQIPs and oversee issuance and completion of CQIPS.
  • Prepare compliance quality assurance reports to present to Compliance Manager.
  • Prepare compliance quality assurance status reports for management teams, carriers, and regulatory agencies as required.
  • Stay current on trends in healthcare and Medicare, reporting, and regulatory compliance.
  • In conjunction with Compliance Manager, consult with management teams on upcoming Medicare regulatory changes that will affect their business.
  • Regularly updating operating manuals and procedural documents.
  • Analyze and interpret quality trends to ensure best practices are in place.

 

Qualifications

  • A Bachelor’s degree is required.
  • Expert knowledge of Original Medicare, Medicare Advantage, Medicare part D and Medicare supplements.
  • 5+ years of management experience required.
  • Compliance and/or Call Quality Assurance experience a plus.
  • Experience with CMS, DOI, Carrier, and Federal regulations, a plus.

 

Skills

  • Proven ability to grow and develop proficient staff through effective and positive leadership, coaching, training, and mentoring.
  • Ability to perform with a high level of accuracy while working independently with minimal supervision.
  • Strong listening, reading, and comprehension skills.
  • Fast learner of complex topics with high memory retention and ability to think critically.
  • Excellent oral, written, and interpersonal communication skills.
  • Self-starter with strong work ethic, well-organized, and excellent time management to be able to multi-task, prioritize, and meet deadlines independently in a fast-paced environment.
  • Positive and self-motivated with the ability to change priorities on-demand.
  • Demonstrated ability to work well individually and in a team environment.
  • Skilled at research and problem solving.
  • Proficient typing skills.
  • Highly proficient with Microsoft Office and Internet knowledge.
  • Ability to adapt to new job requirements as needed.

This is normally an on-site position, located in Allentown, PA. In light of COVID-19 (Coronavirus), we have made temporary arrangements for our staff to be able to work remotely. We will soon return to our offices, at which time, remote work will not be an option for this position. 

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