The primary responsibility of a Quality Analyst is to review Medical Disability Examination (MDE) reports and Disability Benefits Questionnaires generated by medical providers on Veterans evaluated on behalf of the Department of Veterans Affairs.Communicate with medical providers regarding their MDE reports and facilitate any necessary corrections, prior to submission to the VA.Verify that any special requests or necessary second reviews have been completed, consistent with the VA’s preferences.Ensure that all diagnostics requested by the medical provider have been completed, reviewed by the medical provider, and are submitted with the final report.Perform daily queue maintenance to ensure that every case assigned has any updated notes and any needed action has been taken.

Provided service coordination telephonically.Completed assessments and documentation in Multiple Clinical Systems. Inbound/Outbound Calling.Worked with providers and other clinical teams to manage LTSS services.Managed notifications, process referrals, and prior authorizations.Managed Medicaid/Medicare Caseloads.Assisted with PAS and DME services.

• Provide assistance to internal agents by responding to complex customer calls and directing to correct resources.• Identify and resolve anticipated issues to prevent increase of callbacks.• Demonstrate initiative by assisting immediate Supervisor and Business Manager with special projects as assigned.• Comply with all current policies, procedures, and workflows• Utilize resources across multiple departments to address customer escalated issues.• Take ownership for any follow-up work needed for resolving and closing issues.• Partner with pharmacy, billing, and eligibility department representatives to resolve complex customer service inquiries.• Resolve billing escalations related to the (re)calculating of member rates and Premium Payments, research disputed credit, process pay-by-phone credit card, auto-draft check, and mail-in payments.

• Knowledgeable of Medicare Advantage plans, Medicaid, and CMS compliance.• Provide benefit, claims and eligibility information.• Meet established quality, productivity and schedule adherence.• De-escalate situations with callers by providing solutions on a case by case basis.• Provide status and educate members on previously submitted pre-authorization requests.• Research complex issues within multiple databases and work with support resources to resolve customer issues.• Work closely with supervisory staff to complete special assignments.• Conduct training for tenure employees on new line of business and systems.• Provide leadership within the classroom or virtual classroom environment via WEBEX.• Report training metrics and generate training related reports.• Travel to vendor-site to assist with training new hire classes of 25 employees.

• Operate register and provide speedy checkout.• Conduct routine inventory checks and transfer unused merchandise.• Set weekly sales displays and update new sales price tags.• Assist customers with special orders and installation appointments.• Process merchandise rental contracts.• Create and process contractor material request/delivery.• Process credit applications and monthly payments.