Quality Assurance Specialist

Please note: Must reside and be fully authorized to work in the US. **We are seeking remote applicants, preferably in Arizona, Georgia, Montana, North Dakota, Vermont, Illinois, Nevada, Texas or any state except California, Colorado, New Jersey, New York, Oregon, Massachusetts and Washington.

Welcome to Arkos Health! We are a value-based healthcare company providing solutions for payors and providers by combining unique technology with in-home, virtual, and in-clinical care for patients. Arkos serves health plans and provider organizations by managing their highest-risk and highest-cost populations. We are currently in Arizona, Georgia, Montana, Nevada, North Dakota, Illinois and Vermont! Our goal is to be the most valued partner to health plans, service providers, and the community we collectively serve.

How You'll Make a Difference: 

The Quality Assurance Specialist is responsible for monitoring internal phone calls conducted by clinical operations teams and will focus on trending information to improve internal performance. They will assist the Quality Assurance Manager to create performance improvement recommendations for departments not meeting established benchmarks and monitor performance to ensure improvements are sustained. The Quality Assurance Specialist will assist in compliance with federal (i.e., CMS) and state regulations, contracted health plan contractual requirements, and accreditation standards (i.e., NCQA/URAC). The team will be versed in all scheduling and coordination processes to provide checks on critical metrics for the markets such as gap closures, TCMs, field requests/orders, medical records, etc.

Why Arkos? 

• Great Benefits! 
  • Employer-paid Medical, Dental and vision premiums at no cost to you  
  • Employer-paid Short-Term Disability premiums at no cost to you 
  • Employer-paid Life Insurance premiums at no cost to you 
  • Employer matching 401(k) 
  • 15 days annual combined sick/vacation and 10 days of holiday during your first year 
  • Your Birthday off! 

• We have great people and a growing culture! From coffee bars to Ice Cream Day, we recognize our team!  
• We are ranked as the 113th fastest-growing private company in the United States and 11th within the healthcare services sector on the 2024 Inc. 5000 list! Join us today! 

Essential Duties and Responsibilities: 

• Monitor internal calls for compliance to HIPAA rules and regulations, adherence to call scripts, departmental requirements, and communication skills
• Utilize tools and templates that meet regulatory and compliance requirements and are specific to the job function of the individual being audited
• Establish best practice guidelines for Arkos Health employees when communicating with patients
• Participate in formal bi-directional processes and communication pathways to share audit results with appropriate leadership, and department director Quality Assurance Specialist
• Manage feedback from results and trends, and report summaries of results by role to the Quality Assurance Manager for the Quality Improvement Committee
• Assist in training within the Quality Assurance department
• Identify factors contributing to poor results and trends to improve processes and systems and propose solutions
• Maintain knowledge of applicable current rules and regulations in place for Medicare, Medicaid, and Marketplace and ensure market leaders are aware of any changes required to SOP’s or policies
• Conduct member experience surveys and/or collect and analyze completed surveys
• Provide individual results to Quality Assurance Manager for communication to department directors
• Assist leadership in gathering required reports and data for Quality Improvement Committee, and create the presentation as needed, when assigned
• Perform other duties as assigned to support the overall effectiveness of the organization

Qualifications and Skills:

• High school diploma or GED
• At least 1 year experience in customer service
• Bilingual in English and Spanish (Preferred)
• Language & Communication Skills: excellent leadership, management, and communication skills with ability to work collaboratively with other departments and external stakeholders; must be fluent in both spoken and written English and maintain professionalism in all verbal and written correspondence with both internal and external clients
• Decision Making: strong ability to self-manage time to manage multiple projects and priorities in a fast-paced environment
• Computer Skills: able to utilize necessary programs to ensure effective communication, collection of metrics, and proprietary software; including but not limited to: Microsoft product suite, Adobe Suite
• Problem Solving: strong analytical and problem-solving skills
  

What's Next?  

Apply for the Job! Our recruitment team will review your application and reach out to schedule a quick call! 

Please feel free to forward this opportunity to someone you believe might be a good fit! If hired, you could be eligible for a referral bonus!

Must complete our Culture Index Survey. Take the assessment at https://go.cultureindex.com/s/bg3VS0H2kF. This is not a pass/fail test and does not measure intelligence. 

Arkos Health EEO Statement: 

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. 

Arkos Health is a drug-free workplace. All job applicants selected for employment are required to submit to a pre-employment drug test and background check. 

Arkos Health participates in E-Verify to confirm eligibility to work in the United States. To view the details on this program, visit our career page at Careers - Arkos Health