Customer Engagement Quality Auditor (Hybrid)

Position Purpose The Customer Engagement Quality Auditor ensures a superior customer experience by monitoring, measuring, and analyzing calls and completed work. Then, the auditor builds reports and creates action plans to improve customer service and compliance within the department. Auditors represent the voice of the customer to the department and organization by communicating their findings. They advocate on behalf of customers through meetings, training, and process improvement. Auditors support the leadership team by delivering feedback and training to individuals who have direct contact with Engagement Center customers. They thoroughly understand and stay up-to-date regarding changes to the businesses they monitor. The successful Auditor epitomizes Renown's values of Caring, Integrity, Collaboration and Excellence; and models excellent service by demonstrating our We CARE service behaviors with leadership, staff, and customers. The candidate will engage regularly with peers, department leaders, and other internal stakeholders to communicate their findings and suggest ways to improve the patient experience. Nature and Scope This position is responsible for effectively developing, implementing, evaluating and monitoring quality as it relates to Customer Service, primarily through auditing live and recorded calls. For the Referrals team, auditors live-monitor agents and examine completed work to ensure accuracy and completeness. Auditors must have excellent customer service, communication and interpersonal skills to understand the patient journey and ensure our Customer Engagement Teams provide a superior customer experience. Auditors communicate with all levels of leadership and must demonstrate high personal standards of courtesy, performance, diplomacy and confidentiality. Auditors objectively measure what happens during our calls and identify trends and issues as well as root causes. They prepare audit findings and recommendations that clearly communicate risks in terms of impact to the business, employees, and customers. Auditors are privy to confidential patient and employee information. Their findings may be used in employee discipline or other investigations. Auditors must exercise integrity, discretion, and maintain confidence in all areas. In completing the audit functions, this position has authority to review all supporting information needed to analyze and report their findings, including: Call Tracking Records (CTR's), call center recordings, any necessary documentation from all parties, and transaction system criteria. Auditors must be able to document their findings during audits and training by using clear, specific, thorough, and concise written communication. Auditors must keep abreast of all departmental, state and federal changes and developing or revising policies, procedures and statistical reports to ensure compliance with national and local regulations.

Including but not limited to:

HIPAA, State of Nevada Division of Insurance, and Centers for Medicare and Medicaid Services (CMS) and ERISA regulations. Auditors are often called upon to create training and support materials for our agents, including performing department-specific new hire training. The successful auditor will incorporate best practices in the training environment to ensure the successful acquisition of skills. Training materials may include education based on monitoring findings, customer service, compliance, policy changes, benefit plan design, or state and federal regulations. Auditors are instrumental in assuring that CMS surveillance season is successful, including: auditing test calls, escalating issues, communicating trends to all levels of leadership, and identifying opportunities for improvement. This position does not provide patient care. Disclaimer The foregoing description is not intended to be, and should not be construed as, an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum Qualifications Requirements - Required and/or

Preferred Name Description Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. The ability to speak Spanish is preferred. A degree from an accredited college is preferred.

Experience:

Requires a minimum of two (2) years with a preference of four (4) years or more of experience working in customer service, health care, or insurance with progressive growth in responsibilities. Preference for candidates with experience training and giving feedback to colleagues. Preference for candidates from highly regulated industries or thorough understanding of: Health Insurance, Managed Care, Benefit Plan Design, Nevada Revised Statutes (NRS), Medicare Advantage Prescription Drug Plans (MA-PD), ERISA regulations, medical terminology, CPT, ICD9/10, and HCPCS coding. Must have excellent communication and presentation skills. License(s): None Certification(s): Preference for candidates with experience or certification in process improvement such as Lean Six Sigma or Transformational Healthcare Candidates must complete Learning Experience Design certificate and/or credentialing for Epic training within 6 months of hire. Computer /

Typing:

Professional:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Experience with EMR and/or call center auditing systems preferred. Ability to type 30 WPM required 60 WPM preferred.