Quality Analyst

Who We Are:

Tria Federal delivers digital services and technology solutions that support the health and safety of veterans, service members and civilians. For two decades, federal agencies have relied on Tria companies to advance their critical missions and modernize their systems, so that they can uphold their commitment to the American people. Today, we are pushing the boundaries of possibility through partnerships and investments in artificial intelligence and emerging technologies, developing solutions for the biggest challenges that will face government tomorrow.

The Quality Analyst will be responsible for analysis and data trends across various of systems to validate the accuracy, identify any possible issues and implement opportunities for improvement, in the Veterans healthcare industry.

Responsibilities:

• Perform queries on system applications in order to obtain relevant information for appointment scheduling audits and to create daily assignments
• Validate audit data against information from various processing systems to ensure that data is accurate
• Analyze data against applicable policies and regulations to identify potential issues (e.g., appointment scheduling gaps, scheduling accuracy, call center data accuracy, member benefits, provider contracts, billing anomalies, claims processing system issues, state mandates, report validations, etc.)
• Maintain reporting infrastructure, as appropriate (e.g., Excel, SharePoint, Access databases, Reporting & Trending tools)
• Calculate errors / defects using root cause analysis tools
• Communicate audit findings to applicable stakeholders (e.g., error descriptions/totals, rebuttal information)
• Analyze audit findings to identify relevant patterns / trends, and communicate to applicable stakeholders (e.g., leadership reports, quality dashboards, power point presentations)
• Serve on applicable cross - organizational quality committees / work groups to identify / communicate common appointment scheduling quality issues, trends and patterns (e.g., Quality Council)
• Identify, communicate and implement opportunities for improving internal audit/rebuttal processes within the Quality team and applicable stakeholders
• Demonstrate working knowledge of how to utilize and navigate applicable systems, platforms and databases (e.g., MSI, Mitel, PIMS, MedNet)
• Identify and document errors and clearly cite the correct work instruction or source of truth for the noted errors and/or apply proper error coding during the audit process (e.g., error/source codes, removal codes, assessment codes)
• Demonstrate knowledge of the healthcare industry (e.g., call center/outbound/inbound customer service, referral-based programs, billing practices, terminology, legal / regulatory requirements, coding standards, healthcare reform, government agencies)
• Occasional assistance with performing Appointment Scheduling tasks (as an Appointment Scheduling Rep)
• Analyze and monitor Customer Service calls and chats for appointment scheduling activities for accuracy and policy adherence as assigned
• Act as a Subject Matter Expert (SME) for front line audit staff to include Audit the Auditor activities
• Other departmental projects as assigned

Required Skills & Experience:

• High School Diploma / GED (or higher)
• 1+ years of audit quality experience preferably in customer experience performance validation (e.g., appointment scheduling, call center applications, claims, healthcare plan benefits, contract member/provider data loading)
• 1+ year experience of data analysis for root cause determination and gap remediation
• Intermediate to advanced knowledge of Microsoft Office Suite with the ability to create, edit, copy, send and save documents, correspondence, and spreadsheets in Microsoft Word and Microsoft Excel
• Ability to work an 8 hour shift between the hours of 7:00 AM (EST) and 5:30 PM (EST), Monday through Friday and occasional overtime as required
• Understanding of basic quality programs

Desired Skills & Experience:

• Bachelor's degree (or higher)
• Excellent verbal and written communication skills
• Strong analytical skills and exceptional problem-solving skills
• Ability to independently manage multiple priorities
• Demonstrate working knowledge of how to utilize and navigate applicable systems, platforms and databases (e.g., MSI, Mitel, PIMS, MedNet)
• Knowledge of medical terminology (provider specialties, ICD/CPT codes etc.)
• Intermediate to advanced knowledge of Microsoft Office Suite with the ability to create, edit, copy, send and save documents, correspondence, and spreadsheets in Microsoft Word and Microsoft Excel, leadership reports, quality dashboards, power point
• Experience in a related environment (i.e., office, administrative, clerical, etc.) using phones and computers as the primary job tools

Physical Requirements:

• Must have workspace in the home with a door and no distractions

Why Tria?
What defines the Tria brand is more than just our dedication to excellence in our craft; it's our incredible team of dedicated, talented, and passionate people that make Tria so exceptional. As people powering possible, we are all partners in our team's shared success.

As a company that cares about people, we seek to cultivate a culture in which all can thrive personally and professionally. We offer a top-tier benefits package to invest in your physical, mental, and financial health and wellness so that you can be your best self - at work and in life. At Tria, we are growth-minded, entrepreneurial in spirit, and committed to fostering a culture of inclusion and opportunity for all. Whatever your background, your role, your department, or stage in your professional journey, here you will have opportunities to learn new skills, seize new challenges, and advance your career as we grow.

California Consumer Privacy Act (CCPA)

We are committed to protecting your privacy. As part of our compliance with the California Consumer Privacy Act (CCPA), we want to inform you about how we collect, use, and protect your personal information during the job application process. For more details, please review https://www.oag.ca.gov/privacy/ccpa .

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