Healthcare Quality Assurance Specialist (SCA)

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs. Under general supervision the Healthcare Quality Assurance Specialist (SCA) provides support to the departmental quality assurance program. This position is responsible for performing the full range of quality assurance duties, working independently, and exercising judgment and initiative. Positions at this level receive occasional instruction or assistance as new or unusual situations arise and are fully aware of the operating procedures and policies of the work unit. Exercises no direct supervision over staff. Key Responsibilities: The duties listed below are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to this position. Quality reviews work assignment tasks related to specific departmental workflows. Uses available tools to gather data and analyze trends or patterns affecting quality; highlights key successes and shares best practices with staff to ensure continued success in quality of tasks/service performance. Responsible to identify areas of improvements and collaborate with departmental leadership team members to identify and streamline processes and implement processes that enhance the company’s standards of work performance and the customer experience. Provides structured and timely recommendations through verbal and/or written feedback to leadership team. Provides direct individual coaching/feedback to team members using specific examples highlighting positive and negative trends which identify performance strengths as well as areas of improvement needed. Develops and conducts targeted group coaching sessions that address quality deficiencies and/or improvement opportunities. Assists with creation of training materials and performs related duties as assigned. Assesses new hires after training has been completed to determine readiness for moving into support. Observes and complies with all company and mandated rules, regulations, and protocols. Selects a quality sample for assigned staff members, conducts timely QA reviews based on outlined criteria, enters QA results into tool. Runs QA reports summarizing results of QA conducted by staff members, team and department. Follows Quality standard operating procedures. Performs other duties as assigned. Knowledge, Skills, and Abilities Needed: Strong soft skills: ability to interact effectively and constructively with others Outstanding written and verbal communication skills Good critical thinking, questioning, and listening skills; excellent attention to detail Problem-solving and task management skills Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames Ability to handle changing situations and work within a diverse group Ability to work independently but also as a member of a team. Ability to meet objectives with minimal supervision Strong technical skills are desired Required and Preferred Qualifications: Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening. Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety& ergonomics, confidentiality, and dedicated work focus without distractions during work hours. Equal Employment Opportunity at Machinify We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/

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