Teresa A. Email & Phone Number

Nashville, Tennessee, United States

Greater Nashville Area, Tn

Responsible for overseeing, facilitating, and administering ISO standards and methodologies related to the incorporation, maintenance, and continual improvement of the Cognosante Health Data and Communications (HDC) Business Unit (BU) Quality Management System (QMS).

Tn

Nashville

-Provide ownership and accountability for assigned testing and quality assurance monitoring.-Listen to live and recorded inbound and outbound calls to ensure satisfactory service with customers at all levels, ensure data integrity standards are met, and representatives’ ability to design and implement automated and documented processes.-Develop, maintain and execute test cases, ensuring the quality and stability of the system throughout the project.-Document processes to maximize reader comprehension and efficiency, and recommend programmer improvements and corrections to increase quality performance.-Complete complex applications and appeals for both Spanish and English speaking enrollees.-Handle inquiries and customer escalations to resolve issues to the satisfactions of TennCare stakeholders.-Respond to customer inquiries by researching and proving responses to questions, mailing information in response to requests, and referring customers as necessary to fulfill need.-Educate customers and Member Representatives on procedures, benefits and policies of TennCare.-Provide quality assurance scoring and feedback to Customer Service Associates and Supervisors.-Monitor and prioritize workloads to ensure timeliness/quality standards are met.

Nashville Tn

-Assist TennCare members with appealing the denial of a medical service, medication, reimbursement, and billing issues. -Translating information as well as appealing issues for Spanish speaking members.-Lead team on assisting urgent appeals by producing customer resolution quickly. -Training new team members on proper call handling, verifying information through Interchange, and proper documentation of various appeals in the Siebel system. -Use of Interchange to verify member information, benefit package, co pay code, Medicare, QMB, SLMB and direct to appropriate department. -Assist supervisors with monitoring calls and quality of calls -Review medical, pharmacy, and reimbursement appeals before submitting information to the State.

Bachelor'S Degree

Associate Of Science (A.S.)