Quality Assurance Specialist - NEMT MediTrans, LLC - 2.5 Lafayette, LA Job Details Full-time From $16 an hour 6 hours ago Benefits Fuel reimbursement Health insurance Dental insurance 401(k) Paid time off Vision insurance 401(k) matching Qualifications Teamwork Microsoft Outlook Spreadsheets Trend analysis High school diploma or GED Attention to detail Organizational skills Clinical confidentiality policies Data analysis software Time management Full Job Description Position Summary The NEMT Quality Assurance Specialist is responsible for monitoring, evaluating, and improving the quality and accuracy of non-emergency medical transportation (NEMT) services provided to Medicaid members. This position conducts quality reviews of transportation records, provider performance, trip documentation, member interactions, and operational processes to ensure services are delivered accurately, timely, safely, and in accordance with company policies, contractual requirements, and applicable Medicaid guidelines. The Quality Assurance Specialist identifies trends, discrepancies, and areas of non-compliance; documents findings; communicates concerns to appropriate departments and transportation providers; and assists with corrective action and continuous quality improvement initiatives. Essential Duties and ResponsibilitiesQuality Monitoring & Auditing Conduct routine and targeted quality assurance audits of NEMT trips, transportation providers, and operational processes. Review trip records for accuracy, completeness, timeliness, and compliance with established requirements. Evaluate transportation documentation, including trip details, appointment information, pickup/drop-off times, mileage, vehicle type, no-show information, and other required documentation. Review provider performance to identify recurring quality issues, service deficiencies, or potential violations. Perform quality reviews of standard transportation, wheelchair-accessible transportation, public transportation, gas reimbursement, and other applicable NEMT services. Conduct audits of call center, dispatch, standing order, credentialing, claims, and other processes when assigned. Identify discrepancies between scheduled services and services actually provided. Verify that required documentation and supporting records are present and accurately maintained. Provider Quality & Performance Monitor contracted transportation providers for compliance with company and program requirements. Identify patterns of late trips, missed trips, inappropriate cancellations, member complaints, documentation deficiencies, or other service concerns. Communicate identified quality concerns to Provider Relations and appropriate management. Assist with provider corrective action plans and follow-up monitoring. Maintain accurate documentation of provider quality issues and resolutions. Assist with provider performance reporting and quality scorecards. Escalate significant or repeated provider deficiencies to management. Member Experience & Complaint Review Review member complaints and service concerns related to transportation quality. Investigate complaints by reviewing trip records, call recordings, dispatch information, provider documentation, and other available records. Determine whether documentation supports the complaint and identify contributing factors. Document findings clearly and objectively. Escalate serious concerns, potential safety issues, or repeated service failures to management. Assist with identifying trends in member complaints and recommending process improvements. Compliance & Documentation Ensure quality reviews are conducted in accordance with applicable Medicaid requirements, contractual obligations, company policies, and departmental procedures. Maintain confidentiality of member information and Protected Health Information (PHI). Follow all company policies regarding HIPAA, PHI, information security, and appropriate use of company systems. Maintain organized and audit-ready quality assurance documentation. Assist with internal and external audits as requested. Immediately report suspected fraud, waste, abuse, compliance concerns, or serious quality issues through the appropriate reporting process. Data Analysis & Reporting Enter and maintain accurate quality assurance data in designated systems and spreadsheets. Track quality findings, trends, corrective actions, and resolution status. Prepare routine and ad hoc quality reports for management. Analyze quality data to identify recurring problems and opportunities for improvement. Assist with developing department metrics, dashboards, scorecards, and performance reports. Provide management with accurate and timely information regarding quality trends and provider performance. Process Improvement Identify opportunities to improve NEMT operations, member experience, provider performance, and internal workflows. Participate in quality improvement projects and departmental initiatives. Make recommendations based on audit findings and documented trends. Assist in developing and updating quality assurance procedures, checklists, and audit tools. Participate in team meetings and quality improvement discussions. Other Responsibilities Work collaboratively with Provider Relations, Credentialing, Dispatch, Call Center, Claims, Compliance, Health Plans, and other departments. Maintain professional communication with employees, providers, members, and leadership. Meet established productivity, accuracy, and quality standards. Maintain strict confidentiality regarding member, provider, employee, and company information. Perform other duties and special projects as assigned by management. Required Qualifications High school diploma or GED required. Minimum of 1-2 years of experience in quality assurance, healthcare, transportation, Medicaid, customer service, auditing, claims, compliance, or a related field preferred. Experience working with NEMT, Medicaid, healthcare transportation, managed care, or a healthcare-related organization is strongly preferred. Strong attention to detail and ability to identify discrepancies and documentation errors. Strong organizational and time-management skills. Ability to analyze information and identify trends or recurring issues. Excellent written and verbal communication skills. Ability to maintain confidentiality and handle PHI appropriately. Proficiency with Microsoft Office, particularly Excel, Word, and Outlook. Ability to learn and effectively use multiple computer systems and databases. Preferred Qualifications Previous NEMT or Medicaid experience. Experience conducting audits or quality reviews. Experience working with transportation providers. Experience reviewing call recordings or customer service interactions. Experience with quality metrics, scorecards, spreadsheets, or reporting. Knowledge of Medicaid transportation requirements and NEMT operations. Familiarity with HIPAA and Protected Health Information. Experience with Salesforce or other healthcare/transportation management systems. Knowledge, Skills & Abilities The successful candidate should demonstrate: Attention to

Detail:

Ability to identify errors, inconsistencies, and missing information.

Analytical Skills:

Ability to review information, recognize patterns, and draw objective conclusions from documented findings.

Communication:

Ability to clearly communicate findings to employees, providers, and management.

Organization:

Ability to manage multiple audits, assignments, and deadlines.

Problem Solving:

Ability to investigate issues and identify appropriate next steps.

Confidentiality:

Ability to safeguard PHI and confidential company information.

Computer Skills:

Ability to navigate multiple software applications and databases.

Professionalism:

Ability to remain objective, professional, and respectful when addressing quality concerns.

Teamwork:

Ability to work effectively with multiple departments and levels of management. Performance Expectations The NEMT Quality Assurance Specialist will be expected to: Complete assigned audits and reviews accurately and within established deadlines. Maintain a high level of accuracy in all quality assurance documentation. Consistently identify and document quality issues and trends. Follow established audit procedures and quality standards. Protect confidential and PHI-related information. Communicate significant findings promptly to appropriate leadership. Demonstrate professionalism when interacting with employees, providers, members, and external partners. Contribute to continuous quality improvement throughout the organization. Physical & Work Environment Primarily office-based work environment. Requires extended periods of computer and telephone use. May require occasional meetings with transportation providers or other departments. Ability to sit, stand, walk, and perform routine office activities. Must be able to effectively perform job duties with or without reasonable accommodation. Equal Employment Opportunity Medi Trans, LLC is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law. Disclaimer This job description is intended to describe the general nature and level of work performed by employees in this position. It is not intended to be an exhaustive list of all duties, responsibilities, qualifications, or working conditions associated with the position. Management reserves the right to modify duties and responsibilities as business needs require.

Job Type:

Full-time Pay:

From $16.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person