John M.

Developed QA playbooks for Revenue Cycle Management (RCM) workflows, with a focus on medical claims processing and prior authorization operations, aiding in the achievement of monthly quality KPIs. Conducted Quality Talks and calibration sessions to relay client and payer updates regarding claims and authorizations, while elucidating QA methodologies and addressing RCM-related queries. Evaluated performance of representatives following established QA guidelines and playbooks, ensuring compliance and accuracy specific to payers. Performed in-depth evaluations of RCM transactions to assist in resolving operational challenges and clarifying workflow gaps. Created performance reports to monitor operational quality and identify improvement opportunities. Participated in daily client meetings providing updates on quality performance and operational challenges. Communicated payer and client updates regarding RCM operations to ensure alignment. Collaborated with operations leaders to strategize on meeting client SLAs and quality benchmarks. Led onsite QA teams to support claims and authorization programs, promoting process alignment and productivity initiatives.

Created reports and tickets for lost or missing shipments in freight operations. Assisted clients by addressing pricing disputes and generating rate quotes. Updated shipment details, incorporating address, consignee, shipper, and billing information. Coordinated with dispatchers and service centers to ensure effective delivery operations. Handled client inquiries through phone and email, offering real-time updates and solutions. Transferred clients to specialized departments for efficient issue resolution.

Introduced client standards and policies while conducting audits and call evaluations based on these standards. Provided feedback during audits and facilitated one-on-one coaching targeted at improving the performance of team members. Generated daily audit reports to share with operations and communicated with clients through various channels to clarify issues and ensure process alignment. Shared important updates with operations and training teams, contributing to improved site performance.

Assisted and guided new hires in gaining product knowledge and best practices. Handled escalation calls from both new and experienced agents. Supported supervisors in motivating agents to improve attendance, and communicated with the quality department regarding enhancement of agent performance. Conducted refresher training sessions and shared updates for agent awareness.

Handled incoming calls promptly and employed appropriate probing techniques. Actively listened to callers and took ownership of their concerns, following all necessary steps to resolve inquiries effectively. Provided accurate solutions, ensuring comprehensive resolution of issues, and properly documented all interactions.