Quality Coordinator I

Versant Health

Must Reside in United States Remote only

Full time

US$42-46k (annually)

Business Operations

Remote

Dec 3

Quality Coordinator I

Who are we?

Versant Health is one of the nation’s leading administrators of managed vision care, serving millions of our clients’ members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and vision.

 

As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us.

 

See how you can make a difference with the support of strong leadership and a team environment.

 

See Everything, Be Anything™.

 

What are we looking for?

The Quality Coordinator I is responsible for the appropriate classification, research, investigation, documentation and response to all 1st level member/provider complaints, grievances and/or appeals. Evaluate origin of complaints and provide appropriate corrective feedback Contact Center Associates. Analyze trends and make recommendations for improvements.

 

Where you will have an impact:

  • Conduct triage administration, research, investigation and documentation of all Level 1 member/provider complaints, grievances, appeals, and ensure accurate coding of cases into department’s database
  • Initiate member, provider and internal departmental outreach (telephone/email/fax) as part of case investigation
  • Review Contact Center recorded calls as part of case investigations.
  • Work directly with Versant Health Vision’s Medical Director regarding provider and member medically necessary appeals and potential qualify of care challenges
  • Participate in internal appeal committee meetings with members, providers, and clinical staff
  • Use a variety of production reporting tools to ensure casework is resolved timely and accurately
  • Approve resolution actions (additional services, redo’s, refunds, etc.) within allowed authority and escalate to supervisor for appropriate approval
  • Create written acknowledgement and resolutions/determinations and/or partner and provide written investigation summaries to client managers and/or directly with clients as needed
  • Initiate education and feedback to Contact Center associates as a result of root cause analysis, including initiation of corrective actions
  • Consistently achieve standardized departmental production and quality metrics
  • Participate in departmental calibration meetings, providing collaborative feedback on case trending and process efficiencies
  • Maintain a working knowledge of Company benefit plans, contracts, provider networks, and departmental policies and procedures
  • Maintain a working knowledge of state and federal compliance regulations
  • Other duties assigned 

What’s necessary to do the job?

  • Preferred Associate’s in related field or equivalent combination of experience and education
  • 1-3 years of related experience
  • Knowledge and experience in the insurance, health, or vision care industry preferred
  • Proficiency in MicroSoft Office

HIPAA & Security Requirements

All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

 

Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.

 

Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.

 

The wage range for applicants for this position is [$42,000 to $46,000].

All incentives and benefits are subject to the applicable plan terms.


Apply for this position Back to job

You must be logged in to to apply to this job.

Apply

Your application has been successfully submitted.

Please fix the errors below and resubmit.

Something went wrong. Please try again later or contact us.

Personal Information

Profile

View resume

Details

{{notification.msg}}