The Case Management Quality Control Analyst is responsible for reviewing and evaluating the performance of the Program Representatives as they complete their cases and represent TrialCard Market Access and our clients to patients, providers, and pharmacies.

This position requires the ability to work in a constructive, impartial, and collaborative manner by establishing positive work relationships, partnering with the Market Access Leadership team, Training, and Client base. This position requires the ability to gain the confidence and trust of others by demonstrating professionalism and expertise in an ever-changing environment.

• Reviews and evaluates the performance of all representatives using an approved quality scorecard in the areas of patient experience, Federal and Drug Administration (FDA) regulations of Adverse Events (AE)/Product Complaints (PC) and Health Insurance Portability and Accountability Act (HIPAA) compliance, and specific program policies and procedures.
• Analyzes potential call trends through call monitoring and works with the internal departments to develop solutions to improve the patient experience.
• Maintains a thorough understanding of company Standard Operating Procedures (SOPs), process and policy requirements
• Prepares and analyzes internal quality reports for management staff to review.
• Manages disputes and call requests received through ServiceNow portal.
• Participates and/or facilitates internal and external calibrations to identify Client’s needs and expectations.
• Facilitates new hire training and introduces program quality standards and expectations.
• Prepares call records and/or corresponding documents and participates in internal and external client audits.
• Handles requests to locate specific call records from the call recording system and provides reports of findings, and edit call recordings to remove Protected Health Information as requested or according to contractual agreements
• Participates in internal department meetings as needed.
• Contributes to the design of call monitoring formats and Quality standards.
• Identifies and reports pharmacovigilance information as required by client(s) (i.e., Adverse Events).\\
• Conducts miscellaneous tasks or projects as assigned

• High School Diploma or equivalent required
• Minimum of 2 years of QA/QC audit experience required
• 2-3 years of customer service, reimbursement/insurance, healthcare billing, physician office or health insurance processing experience required
• Intermediate knowledge of FDA regulations of AE/PC and HIPAA guidelines
• Must be a motivated self-starter with the ability to work independently and cooperatively within a cross functional environment
• Must be able to manage priorities while working independently without direct supervision and be able to direct and manage the work of others with a high level of professionalism and integrity.
• Must be flexible and have the willingness and ability to respond to changing circumstances and expectations readily punctuality and reliability
• Must be able to problem solve and make independent decisions with high level of confidence
• Must be able to collect, gather, visualize, and analyze data in detail.
• Ability to be fair and impartial
• Display a high level of professionalism, integrity, maturity, and maintain a positive attitude
• Excellent verbal and written communication and interpersonal skills
• Strong planning, time management, attention to detail and organizational skills
• Comfortable interacting with all levels of management and personalities
• Basic knowledge in MS Office (Word, Excel)
• Basic knowledge of monitoring software preferred (i.e. Zoom Call Recording, Calabrio, NICE Call Recording, etc.)