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Verida, Inc. · 1 day ago

Supervisor, Quality Assurance and Utilization

Corporate HQ Villa Rica, Villa Rica, GA, US

Full-time

Onsite

Mid, Senior Level

2+ years exp

Verida, Inc. is seeking a Supervisor for Quality Assurance and Utilization. This role involves providing leadership support for both the Quality Assurance and Utilization Review teams, while also performing the functions of both roles as needed.

Government Administration

Responsibilities

Receiving, investigating, compiling, and reporting transportation complaints, as well as those related to Medicare Client Grievances for Centene and WellCare

Reviewing Inquiries DCH North | DCH Atlanta

Closing Inquiries DCH North | DCH Atlanta

Reviewing Grievances for Medicare Clients: Centene and WellCare

Closing Grievances for Medicare Client: Centene and WellCare

Sending RFEs (Request for Explanation) to transportation providers

Mastery of various applications: InSight, Provider Portal, Lyft Concierge, Verida

Coverage of the Atlanta QA Voicemail Box

Assigning members to MCA (Member Care Advisory) List and updating this information via InSight

Sending Productivity Report at day’s end

MCA Trip Monitoring

MCA Documentation via trip notes, manifest notes, member main file notes

MCA Workflow

DCH Trip Monitoring and Reporting

Emailing MCA Same Day | MCA Next Day Reports

Reviewing and making approval/denial determinations for all member transportation requests that are outside of the geographical mileage guidelines and reviewing requests to non-covered Medicaid services and or locations

Responsible for reviewing and making approval/denial determinations for facilities wishing to participate in the organization’s Subscription/Standing Order Transportation Program

Responsible for reviewing Subscription/Standing order transportation requests from approved facilities for NEMT

Investigates transportation provider complaints lodged against Medicaid members during transportation and issuance of Member Warning Letters as warranted

Responsible for completing the three departmental reports: daily denial letters, member no-show letters, and monthly denial summary

Monthly Denial Summary Report: This report is pulled and sent to DCH of all types of transportation denials for each region (Atlanta and North)

Qualification

Quality AssuranceUtilization ReviewMedicareMedicaid knowledgeMicrosoft WordMicrosoft ExcelMulti-taskingAnalytical thinkingCommunicationInterpersonal skillsOrganizational skills

Required

1-year minimum experience in Quality Assurance and or the Utilization Review Departments

1 year or more experience in billing for Medicaid/Medicare and or private insurance

2 years or more work experience and or employment in a paid healthcare-related industry

2 years or more supervisory/managerial role in healthcare-related industry

Minimum Associates Degree or higher in a healthcare-related field

Preferred

Knowledge of Medicare and Medicaid, community resources, dialysis, and the nursing home placement process

Must possess entry to mid-level proficiency in Microsoft Word and Excel

Excellent written and verbal communication skills

Possesses and demonstrates multi-tasking skills in a high-stress environment while working with multiple internal departments, as well as external entities

Analytical thinker with good judgment

Well-organized, self-directed individual, who is flexible and takes direction well

Possesses a high level of interpersonal skills to handle sensitive and confidential situations