QA Analyst - Patient Support

Monitor and evaluate recorded and/or live patient support interactions, case documentation, and related workflow activity using approved scorecards and client/program standards. 

Assess the accuracy and completeness of information provided regarding copays, deductibles, coinsurance, out-of-pocket responsibilities, eligibility, benefit verification, copay programs, and other assigned patient-support topics. 

Evaluate pharmacy claim-support activity for adherence to established procedures, including common rejections, refill-too-soon issues, coordination of benefits, prior authorization status support, plan limitations, and appropriate escalation. 

Evaluate patient identity verification, HIPAA/privacy practices, required scripting or disclosures, documentation quality, professionalism, empathy, and adherence to call and case-handling procedures. 

Promptly escalate critical errors, compliance or privacy concerns, patient-safety concerns, and material process deviations through established channels. 

Participate in regular calibration sessions with Quality, Operations, Training, and other stakeholders to promote consistent scoring and interpretation of standards. 

Provide clear, objective, documented feedback identifying strengths, errors, and improvement opportunities for leader coaching and development. 

Analyze recurring quality trends, error patterns, customer-experience themes, and process breakdowns and communicate actionable findings to Quality, Operations, and Training leadership. 

Recommend refresher training, job aids, workflow clarification, scripting updates, or process improvements when recurring quality gaps are identified. 

Support new-hire nesting, targeted monitoring, remediation efforts, and other quality initiatives while maintaining objective evaluation standards. 

Complete assigned quality reviews within established productivity, timeliness, and accuracy expectations and maintain complete audit records. 

Track and report quality results, critical-error trends, documentation accuracy, compliance findings, and other assigned quality measures using approved tools. 

Maintain confidentiality of patient information, employee performance information, recorded interactions, and audit findings and follow all applicable HIPAA, privacy, information security, and client requirements. 

Support internal, client, and program quality reviews by organizing audit evidence, validating findings, and providing supporting documentation. 

Follow Omega and client quality policies, scorecards, escalation paths, and security requirements and raise unclear or conflicting standards for review.