Workforce QA Manager- Remote

 

 

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.

 

Summary:

We are seeking a highly skilled and detail-oriented Workforce QA Manager to oversee vendor operations, workforce management, quality assurance functions, and training initiatives. This role is responsible for ensuring optimal vendor performance, managing inventory and reporting processes, monitoring key performance indicators (KPIs), and implementing quality control measures to enhance productivity and revenue performance. Additionally, the Workforce QA Manager will develop and oversee a structured training program for new hires and existing employees, ensuring continuous skill enhancement and compliance with standard operating procedures (SOPs). The ideal candidate will possess strong analytical skills, leadership capabilities, and a proactive approach to operational excellence.

 

Responsibilities:

 

Vendor Coordination & Workforce Management:

• Oversee vendor operations, ensuring alignment with organizational goals and contractual obligations.
• Manage inventory loads and transfers to meet operational requirements, ensuring accuracy through regular audits.
• Maintain accurate records of vendor performance and workforce efficiency.
• Onboard and offboard vendor agents, providing training and guidance as needed.
• Host weekly office hours for vendor agents to address inquiries and provide support.
• Communicate changes in carrier, provider, or claims processing guidelines to ensure compliance.
• Aid in resolving application, system, and technical issues escalated by vendor agents.

 

Quality Assurance & Performance Monitoring:

• Conduct regular QA assessments to ensure adherence to company standards and processes.
• Establish and oversee quality assurance programs to ensure compliance with industry regulations.
• Identify deficiencies and recommend actionable solutions to enhance team performance.
• Develop quality control measures to improve service delivery and operational efficiency.
• Monitor productivity metrics, including quality, efficiency, and revenue generation, to identify areas for improvement.

 

Reporting & Data Analysis:

• Prepare and distribute comprehensive reports on inventory status, workforce productivity, and revenue performance.
• Track and analyze KPIs to measure workforce effectiveness and efficiency.
• Develop and maintain dashboards and reports using Tableau and other tools to provide real-time insights to leadership.
• Utilize Tableau, Teradata Studio, Deep Sea, other analytic tools, and Daily Reporting for performance monitoring and optimization.
• Analyze workforce trends and provide data-driven recommendations for operational improvements.

 

Leadership Readout & Process Improvement:

• Facilitate weekly leadership meetings to provide updates on vendor operations, productivity metrics, and revenue performance.
• Present findings, recommendations, and action plans to senior management.
• Create and maintain detailed documentation of processes, workflows, and reporting methodologies.
• Identify opportunities for process enhancements and lead implementation efforts.

 

Training & Development:

• Develop, implement, and oversee a structured training program for new hires to ensure proficiency in company polic