Quality & Audit Resume Samples

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P Heathcote

Providenci

Heathcote

1257 Clementina Lodge

Philadelphia

+1 (555) 842 8814

1257 Clementina Lodge

Philadelphia

Phone

p +1 (555) 842 8814

Experience Experience

Detroit, MI

Quality Audit Manager

Detroit, MI

Adams-Johnston

Detroit, MI

Quality Audit Manager

Delivering Quality Audits which provide added value through continual improvement of banking services
Monitors and audits Process Control Forms, breakdowns and resolution. Provides review and audit
Provide necessary feedback in all phases of Insurance Services
Maintain professional ethical standards by promoting and fostering a workplace that meets Willis / Loan Protector core values
Leading team of Quality Audit Managers
Administer Quality Assurance Guidelines and Procedures for Insurance Tracking Operations
Delivering an internal compliance audit service incorporating audit schedule in accordance with UBS Policies and Procedures

San Francisco, CA

Quality Audit System Manager

San Francisco, CA

Terry LLC

San Francisco, CA

Quality Audit System Manager

Proactively work with the leadership at each site to drive continuous improvement to ensure on time delivery and quality for our Members
Manage Corrective Actions to closure
Development of metrics (CAPARs)
Be a business partner to Operations ensuring the Quality Control team is a leading driver in both the compliance and management of all fulfillment processes
Support the site Quality Team to drive the objective of 100% first pass yield, zero customer escapes, proactively supporting 100% on time delivery for the business operations
Provide leadership / guidance on all Internal Audit matters as well as product compliance to the facility
Organize and promote company-wide improvement efforts

present

Boston, MA

Quality Audit Systems Manager

Boston, MA

Swaniawski Inc

present

Boston, MA

Quality Audit Systems Manager

present

Selecting the processes to audit
Defining the audit protocols (what to audit, objective evidence, checklists etc.)
Establishing and maintain the standards for the expected outcomes from all the audits (e.g. Summary of Findings, Corrective Actions, etc.)
Development and deployment of continuous audit training (Internal auditors and Operations)
Acts as the liaison with external parties, including regulatory agencies during audits / assessments
Execute audits including opening and closing meetings
Provides advice on internal control and participates in enhancing internal audit standards and practices

Education Education

Bachelor’s Degree in Science

Howard University

Bachelor’s Degree in Science

Skills Skills

Intermediate Other Knowledgeable of current trends in quality improvement in managed health care
Intermediate Other Solid understanding of managed care and the health care industry in general
Intermediate Ability to lead/manage others
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Demonstrated ability to deal with confidential information
Advanced Demonstrated organizational skills
Advanced Demonstrated interpersonal/verbal communication skills
Advanced Demonstrated written communication skills
Intermediate Other Strong background in Quality Improvement, including planning, evaluation, quantitative analysis, and practical application of quality management principles in a managed care environment
Intermediate Demonstrated leadership skills

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15 Quality & Audit resume templates

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Quality Audit Manager Resume Examples & Samples

Leading team of Quality Audit Managers
Actively managing PEX quality /projects drawing on practical experience, industry best practice and knowledge
Leading transformation programs
Designing process and products
Delivering an internal compliance audit service incorporating audit schedule in accordance with UBS Policies and Procedures
Ensuring that all Internal Compliance Audit activities are conducted objectively and in consistent manner
Delivering Quality Audits which provide added value through continual improvement of banking services

Quality Audit Claims Specialist Resume Examples & Samples

Experience processing both Commercial & Medicare claims
Minimum 2 years of medical claims processing experience in CAS
Beginner to intermediate experience with MS Office Excel
Proven ability to utilize analytical thinking in determining root cause from audit results data
Ability to work in a dead-line driven and production based environment
Strong attention to detail and accuracy
Experience with MTV
Microsoft Access experience
SharePoint experience

Quality Audit Manager Resume Examples & Samples

Administer Quality Assurance Guidelines and Procedures for Insurance Tracking Operations
Provide necessary feedback in all phases of Insurance Services
Ensures delivery of QA department goals and objectives
Monitors and reports on processes and outputs from the Escrow and Insurance Processing
Departments to ensure and maintain optimal operations efficiency and effectiveness
Ensure all procedures and policies are defect free and compliant with SLA (service level agreement)
Specifications
Monitors and audits Process Control Forms, breakdowns and resolution. Provides review and audit
Of the process analysis and resolution steps. Provides feedback, escalation and approval when appropriate
Oversees vendors by monitoring and reporting through weekly and monthly quality audits of their performance according to the agreed upon services provided to Loan Protector
Recruits and maintains a high performing team in support of Loan Protector’s Compliance Program and develops/trains assigned Quality Audit staff for success by providing requisite technical regulatory compliance and process training
Bachelors Degree in Business/Management Required
5+ years experience of financial services, compliance auditing, or related experience
Management experience and exposure to lender placed insurance, and / or mortgage servicing preferred
Six Sigma Green Belt Required, Black Belt preferred
Exceptional planning and execution skills
Strong interpersonal skills required for working with all levels of management while maintaining confidentiality and utilizing discretion in sensitive situations
Maintain professional ethical standards by promoting and fostering a workplace that meets Willis / Loan Protector core values
MS Office Suite, advanced Excel skills
Strong and effective communication, organization, planning, and problem-solving skills
Ability to work as a part of a team within a fast paced environment
Excellent statistical and numerical ability
Exceptional analytical capabilities. Ability to grasp key points from complicated details

MRA Quality Audit Specialists Resume Examples & Samples

Bilingual in Spanish required
Bachelor’s Degree or equivalent experience required
Quality background desired

Quality Audit Manager Resume Examples & Samples

Bachelor’s degree in scientific, engineering or technical field with 5+ years’ experience in a medical device, biotech or pharmaceutical quality system OR Master’s degree in scientific, engineering or technical field with 3+ years’ experience in medical device, biotech or pharmaceutical quality system
3+ years’ management experience in a complex environment
Displays and inspires enthusiasm and ownership across the organization while translating high-level business objectives into operational strategies, objectives, plans and tasks
Demonstrated track record of understanding and applying FDA’s Quality System Regulation and ISO 13485 requirements for quality management systems
Experience interacting with regulatory agencies during audits and inspections
Strong proficiency in Microsoft Word, PowerPoint, and Excel
Master’s degree in business, technical, engineering or scientific field
ASQ Certified Quality Auditor/Biomedical Auditor, Certified Quality Engineer, or Certified Manager of Quality/Organizational Excellence
High degree of analytical and critical thinking, application of good judgment and ability to communicate in writing clearly and concisely, using excellent grammar and sentence structure
Superior communication skills (articulate and persuasive)
Proven track record of achieving results through influence management and motivating teams
Knowledge of Medtronic and its products
Demonstrated knowledge of and expertise utilizing Six Sigma/Lean tools to solve complex quality system problems

IT Quality Audit Manager Resume Examples & Samples

Professional certifications should include CISA, CISSP, and/or CISM
At least 5-8+ years of IT Auditing experience, with “Big 4” or other recognized auditing firm preferred
Industry experience in the areas of IT internal audit, Security, Quality, ITIL process a plus
Excellent organizational, project management, written and verbal communication skills
Strong analytical and negotiation skills
Detail oriented, able to multitask and meet deadlines
Familiarity with IT risk assessment and audit methodologies, (i.e. COBIT)
Ability to interact with employees at all levels of the organization including executive management critical
Exposure to Archer or other risk management / automated work paper tool helpful
Working knowledge or exposure to Life Science industry laws and regulations in the areas of GxP, SOX, Privacy, and / or Data Integrity

Manager, Quality Audit Resume Examples & Samples

Communicates and presents quality review findings to business leaders; advises on financial impact & implications of identified risks
Develops & implements quality audit metrics and scorecards to analyze & assess trends as well as identify and prioritize quality issues & control gaps
Evaluates, develops and implements process improvements based on output of quality audits completed by his/her team
Executes quality control initiatives and/or solutions to identify & remediate quality issues and/or gaps in business procedures, processes, or systems
Leads more complex reviews & testing procedures to determine compliance with critical and required controls (e.g. company procedures, Sarbanes-Oxley, ERISA, etc.)
Leverages data & analysis to develop remediation plans, recommend complex solutions and/or procedural changes to reduce risk and improve business results
Manages a team to conduct quality audits for assigned area; facilitates participation & responsiveness from key stakeholders
Monitors and evaluates remediation action plan progress to ensure successful resolution of identified risk/control gaps
Oversees and evaluates quality assurance & control process documentation prepared by team to ensure proper documentation of testing & support conclusions
Partners with business leaders to develop corrective action plans; gains consensus among management to effectively implement plans to control risks & identified gaps
5-7+ Years of audit or quality assurance experience directly aligned to the specific responsibilities of this role; including 2+ years of managerial, supervisory, and/or demonstrated leadership experience (Required)
4 Year/Bachelors Degree or equivalent work experience (4 years of experience in lieu of Bachelors) (Minimum Required)

Documentation, Quality & Audit Manager Resume Examples & Samples

Provides leadership and direction for the unit in accordance with the overall strategic direction of the department
Serves as the content expert of the responsible area, providing assistance and advice
Communicates information effectively, translating financial data into meaningful information that support business decision-making
Applies understanding of operational and financial performance to anticipate and meet the needs of clients
Holds unit to high standards of performance
Assures integrity of data and analysis
Defines and frames complex issues and develops time tables/processes for decision making
Facilitates the ongoing learning, well-being
Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.g, professional satisfaction and development of staff through training, work assignments, increased responsibility/autonomy and mentoring
Minimum seven (7) years of directly related financial experience with a variety of projects
6-10 years of coding experience

Quality Audit System Manager Resume Examples & Samples

Advocate for the VOC (Voice of the Customer) ensuring customer requirements are realized throughout the life cycle of the products and processes used within the facility; from development through product realization and service support
Help identify, measure and in collaboration with the Operations and the Quality Control team to reduce the Cost of Poor Quality
Possess the ability to make decisions that always protect safety of the products and services provided by the business
Establish procedures for maintaining high standards of quality, reliability and safety
Be a business partner to Operations ensuring the Quality Control team is a leading driver in both the compliance and management of all fulfillment processes
Verify, track and appropriately escalate NC / CAPA issues that could impact quality or timelines
10+ years of experience with Quality
3+ years in a Quality Audit role
Customer-first mindset with the drive to understand internal and external customer expectations and requirements
Master's Degree
Aerospace, healthcare, medical device, pharmaceutical experience
Experience supporting Class 3 Non-Conformances; experience working with internal or external audits

Claims Quality Audit Rep Resume Examples & Samples

Performs routine and moderately complex audits on paper and electronic claims for payment integrity in alignment with regulatory standards and timelines, business policy, contract, appropriate coding, and system configuration with ability to extract and audit exception audit reports
Participates in communication with Business Operations management regarding trends in order to improve claims processing accuracy and documented business rules for incorporation into training programs, policies and procedures
Identifies and escalates issues related to instructional material that is inaccurate, unclear or contains gaps. Provides recommendations for correction of this material. Confers with management to assess training needs in response to changes in policies, procedures, regulations, and technologies
Performs special project audits and reviews as requested by other departments/regions
Associate’s Degree (AA) or 2-3 years related experience and / or training; or equivalent combination of education and experience
3-4 years medical claims knowledge
Ability to speak effectively before groups of customers or employees of the organization
Ability to deal with problems involving several concrete variables in standardized situations
Knowledge of healthcare regulations and guidelines including CMS and MHC as pertains to AB1455
Knowledge of Correct Coding Initiative, HCFA-1500 and UB-92 claim forms, and CPT Coding
Intermediate skill levels in Microsoft Word, Excel, Access, and Outlook
Ability to navigate internet
Ability to operate general office equipment, i.e. Copier, fax

Senior Quality Audit Rep Resume Examples & Samples

Lead, design, monitor, review, and evaluate the quality provided by department staff to measure service quality and identify non-conformance on all cases, to include those that are most complex, while maintaining production and time service goals. On a regular basis, provide coaching and feedback to individual staff members throughout the entire chain of our operations
Schedules reviews, handles appeals and/or elevated issues, and assist management with the execution of changes to our programs as needed
Validate accuracy of decisions/processes for adherence to set standards and/or applicable regulations or requirements. Work with internal and external parties for resolution and overall design
Develop, design, and prepare reports of quality results for use by management in evaluating performance or developing training
Personally take accountability to execute and perform standard and complex eligibility functions that are impactful throughout entire chain of our processes
Maintains confidentiality in the collection, maintenance and dissemination of restricted, sensitive or other information as identified by management
Establishes and maintains effective working relationships with personnel at all levels of the Company to assure the successful implementation and delivery of programs
Utilize all facets of seasoned working knowledge to recommend billing and enrollment alternatives to support the most complex and non-standard requests to establish processes and systems
Advanced Customer Service skills and ability to work effectively with various levels of personnel
Strong coaching and mentoring skills
Strong verbal and written communication and the ability to articulate instructions and information to other associates and customers
Strong analytical ability, sound judgment and math aptitude
Ability to work well under pressure and deadlines
Highly proficient with personal computer and software applications/data entry and ability to train others
Seasoned experience and knowledge/skills in presentation
Seasoned knowledge of group insurance concepts and operations
Thorough knowledge of all the Company's product lines
Thorough knowledge of applicable laws and regulations
Seasoned experience with Compass system and GSAP (Group Sales Application)
Strong knowledge of eligibility rules

Quality Audit Systems Manager Resume Examples & Samples

Provide guidance and leadership on all Internal Audit matters as well as product compliance to the facility
Help identify, measure and in collaboration with the Operations and the Quality Control team, reduce the Cost of Poor Quality
Organize and promote company-wide improvement efforts
Support the implementation and maintenance of the company’s Quality Management System (QMS) in accordance with current quality standards, reporting on performance of the quality system for review and as a basis for improvement
Support the site Quality Team to drive the objective of 100% first pass yield, zero customer escapes, proactively supporting 100% on time delivery for the business operations
Acts as the liaison with external parties, including regulatory agencies during audits / assessments
Coordinate audit schedules across all sites
Proactively work with the leadership at each site to drive continuous improvement to ensure on time delivery and quality for our Members
10+ years of experience with Quality (Quality experience in a plant or manufacturing environment preferred)
Previous experience in developing and implementing an internal Quality audit program
Knowledge or experience with data trending, metrics generation, authoring protocols / reports
Knowledge with processes involved in manufacturing and distribution: QA, QC, validation, and process development
Capability to assimilate information and influence timely decisions that impact the functional areas
Knowledge and experience with Class 2 Non-Conformance

Quality Audit Systems Manager Resume Examples & Samples

Plans compliance and operational audits
Develops and conducts audit training
Conducts risk assessments and identifies controls to mitigate identified risks
Performs audit procedures to verify that controls are operating through testing and interviewing techniques
Analyzes and concludes on effectiveness and efficiency of control environment; identifies control gaps and opportunities for improvement
Manages scheduling of audits and through a matrixed organization - resources for audits
Documents the results of audit work
Prepares timely audit reports and conducts audit summary meetings with local and business unit management
Assess, evaluate and promote compliance to internal policies
Contributes, as appropriate with external auditors through select substantive procedures as well as process walkthroughs and testing of controls as applicable
Assists in internal investigations as needed
Provide leadership / guidance on all Internal Audit matters as well as product compliance to the facility
7+ years’ of progressively more responsible work experience in any of the following functions: auditing, demonstrating the ability to execute complex audit procedures, develop corrective actions alternatives, prepare comprehensive, clear and concise audit findings and maintain objectivity and impartiality
7+ years of experience with Quality
Proven project management skills and demonstrated experience balancing multiple tasks
Effective written and verbal communication skills
Demonstrated proficiency in Microsoft Office applications and data analysis tools
The ability to work well under pressure including the ability to communicate with a high degree of confidence
Communicates clearly, credibly, persuasively and with appropriate frequency; develops and uses personal impact to influence others to act positively
Builds strong working relationships both inside and outside the organization
Responsible for own actions and work product, follows through on commitments, produces desired results
Proven ability to adapt to change in direction and priority in a fast - paced, deadline - oriented environment
7+ years of experience in Manufacturing
7+ years of experience working in the following industries Aerospace, healthcare, medical device, and or pharmaceutical
Professional certification (CIA , CQA) strongly preferred
Ability to travel 10 - 20% desirable
Knowledge and experience with Class 2 Non - Conformance

Specialist, Quality Audit Resume Examples & Samples

Analyzes and evaluates trends, identifies control gaps, and recommends solutions or procedural changes
Collaborates with appropriate internal stakeholders (e.g. management, training, finance) to develop remediation action plans of identified risks/control gaps
Communicates review findings to internal stakeholders and recommends corrective action plans to control weaknesses
Conducts reviews and testing to determine compliance with critical and required controls (e.g. Company policy, SarbanesOxley, ERISA, etc.)
Develops and executes quality assurance and control review test plans including incorporating various possible methodology of achieving results, documents results and evaluates results to assess the quality of the control and/or control environment
Executes quality assurance and control reviews to identify and remediate quality issues and gaps in business procedures, processes or systems
Identifies and communicates financial implications of identified risks to management
Identifies internal control gaps in business procedures, processes or systems, and initiates appropriate remedial action
Prepares and evaluates process documentation to adequately document testing performed and to support conclusions reached
1 - 3+ Years of Quality Assurance experience that directly aligns with the specific responsibilities of this position(Required)
4 Year/Bachelors Degree or equivalent work experience (4 years of experience in lieu of Bachelors) in (Minimum Required)

Quality Audit Group Leader Resume Examples & Samples

Understanding of GVDP and Quality Processes
Proficient oral and written communication skills
Proficient in MS Office Applications (Word, Excel, PowerPoint)
Assembly plant experience (resident or support function)

Associate Director IT Quality Audit Resume Examples & Samples

7-10 years of auditing experience in a highly regulated environment. Must demonstrate extensive knowledge of the principles, theories and concepts of computerized system auditing for compliance to GMP regulations
3-5 years of experience in delivering validated IT solutions or an application support role
Familiarity and practical experience in the implementation of quality systems in a pharmaceutical or biotechnology manufacturing environment
Six-Sigma Green Belt Certification

Senior Specialist IT Quality Audit Resume Examples & Samples

Conducts computer system audits of GMP systems/operations to ensure compliance with prevailing regulatory laws and company policies through the computer system life-cycle
Conducts remote assessments and on-site vendor audits in support of the procurement and life-cycle monitoring of computerized system software and third party IT services
Responsible for the audit planning, audit execution and formal reporting of all audit results to the responsible management. Ensure responses to each audit observation is obtained and that appropriate remediation and corrective or preventive actions are taken and tracked to closure
Presents the results of audits to senior site and divisional management, including practical recommendations to address identified risks; requiring strong negotiation and influence skills
Supports the development of the GMP computerized system internal and external audit programs inclusive of procedure creation, audit tools and training delivery
Supports the annual development and maintenance of a risk-based audit plan/schedule including scope definition
Provides GMP computerized system quality and compliance consultancy and expertise to colleagues
Supports the analysis of quality and compliance data in order to identify and lead targeted continuous improvement efforts to improve operational process effectiveness through timely investigations and effective CAPA
Monitors trends, identifies compliance issues and determines opportunities for quality improvements within customer areas
Requests applicable resources to support audit plans
Is responsible for ensuring delivery of high quality and timely audit information to appropriate levels of management
Ensures independent and non-biased role in working with quality and compliance functional area groups to prevent any audit conflicts of interest. Collaborates with quality and compliance colleagues, as appropriate, to assure adequate focus
Responsible for practical knowledge of current and emerging global guidelines and regulations, relevant regulatory approaches and actions to effectively develop and advance audit strategies
Limited supervision required in day-to-day activities
Requires approximately 50 – 75% domestic and International travel for up to two weeks in duration
5-7 years of auditing experience in a highly regulated environment. Must demonstrate extensive knowledge of the principles, theories and concepts of computerized system auditing for compliance to GMP regulations
2-3 years of experience in delivering validated IT solutions or an application support or vendor oversight role
2-3 years in a management role with proven accountability, and demonstrated excellent interpersonal, communication, negotiation, influencing, and problem-solving capabilities
Good understanding of a IT technology operations
CISA, CISP Certification and knowledge of frameworks established under COBIT and ITIL

Claims Quality / Audit Rep Resume Examples & Samples

Reviews written dispute requests received from providers of denied or incorrect payments based on contractual arrangements with providers and non-contractual providers. Regarding either Professional or Institutional Claims
Provide expertise claims support by reviewing, researching, investigating, auditing claims
Analyze and identify trends and provides feedback and reports to reduce errors and improve claims processes and performance
Responsible for all aspects of quality assurance
Performs complex and extensive research, analysis and logical conclusions of paper and electronic claims to resolve disputes by providers, members and health plans
Conducts necessary follow-up with internal departments within set timeframes to validate payment integrity related to regulatory agencies, contracts, policy, coding, and system configuration
Acts as a department resource and gives support to Customer Service and researches Practice Connect issues for resolution. Responds to provider calls related to provider disputes and appeals for incoming provider/member disputes
Identify, trend, and report the Provider Dispute and Adjustment process for Monarch Healthcare management and prepare reports for management summarizing observations and recommendations for quality improvement
Provides qualified data to the Business Operations Compliance & Regulatory Manager for incorporation into training programs and policies and procedures. Confers with management to assess training needs in response to identified trends
Collaborates with other departments and management to implement and reinforce policy quality standards
Please note: This position would be in-office in either our Irvine or Long Beach, CA office locations. If a candidate is selected for Long Beach, they would need to train in our Irvine office first
3+ years of experience as a Claims Examiner with previous Medicare and HMO experience
3+ years of experience with dispute and resolution process (AB1455), provider appeals, Correct Coding Initiatives (CCI edits), contract language interpretation, health plan eligibility and health care benefits, or equivalent combination of education and experience
Intermediate skill level with Excel
Knowledge of Correct Coding Initiative, HCFA-1500 and UB-92 claim forms and CPT Coding
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry
Ability to apply commonsense understanding to carry out instructions furnished in written, oral, or diagram form
Ability to comprehend, interpret and apply provider contract language

Mgr, Quality & Audit Resume Examples & Samples

Partners with key stakeholders across all lines of business during external and internal audits in order to provide appropriate documentation and ensure the audits are conducted in accordance with Audit Methodology and professional standards
Develops QA standards to monitor and improve adherence to department standards, policies and procedures, templates, formats and guidelines
Develops and implements studies of business function systems to include score, action plans, and analysis. Prepares narratives and graphic display of the findings
Communicates audit results to senior management on a regular schedule
Focuses on developing a systematic report quality results to help process owners root cause and prioritize their process or training opportunities
Direct involvement in building collaborative relationships with other departments to resolve quality issues and barriers
Leads and/or performs special projects, when necessary
Performs administration and personnel duties to include associate development, team meetings, hiring activities, etc
Required A Bachelor's Degree in a related field
Required or equivalent work experience
Required 3+ years of experience in relevant work as a senior, lead associate and / or supervisor - for internal applicants
Required 5+ years of experience in directly relevant work experience to include at least 3 years as a senior, lead associate and / or supervisor. Solid understanding of managed care and its place in the health care industry. directly relevant work experience to include at least 3 years as a senior, lead associate and / or supervisor. Solid understanding of managed care and its place in the health care industry. relevant work to include at least 3 years as a senior, lead associate and / or supervisor. Solid understanding of managed care and its place in the health care industry - for external applicants. directly relevant work experience to include at least 3 years as a senior, lead associate and / or supervisor. Solid understanding of managed care and its place in the health care industry
Intermediate Demonstrated leadership skills
Intermediate Ability to lead/manage others
Advanced Demonstrated written communication skills
Intermediate Demonstrated ability to deal with confidential information
Advanced Demonstrated organizational skills
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Other Solid understanding of managed care and the health care industry in general
Intermediate Other Strong background in Quality Improvement, including planning, evaluation, quantitative analysis, and practical application of quality management principles in a managed care environment
Intermediate Other Knowledgeable of current trends in quality improvement in managed health care
Intermediate Other Knowledgeable of AHCA and CMS regulatory requirements
Intermediate Other Knowledgeable of HEDIS and CAHPS requirements
Required Intermediate Microsoft PowerPoint

Senior Specialist Quality Audit Resume Examples & Samples

Ensure procedures are consistently applied as per the company's compliance standards and feedback given via reports/evaluation forms
Responsible for conducting one or a variety of the following audit types that range from low to high complexity
Guest service credit card contacts
Past due account contacts
Credit billing disputes, ensuring disputes are processed and resolved in a timely and efficient manner and within Fair Credit Reporting Act, VISA Guidelines, and Federal Regulations
Team Member & Retail Service contacts
Target internal business partner contacts; such as, stores, point of sale, headquarters, password reset, and Pharmacy
Transactional based processes ensuring compliance to regulatory requirements and internal policies for Target Contact Centers
Attends weekly discussion on policy/procedure and quality issues to ensure consistency of process
Surfaces trends or retraining issues to Leader
Use contact recording software; i.e., Witness, SmartCenter, and various contact center tools and applications
Ability to subjectively determine and document if best practices are being followed by Audit teams
Make recommendations for process improvement and participates in the implementation of new initiatives
Drive the different initiatives in Target India with enthusiasm and in a fast, fun and friendly way
Build strong partnerships across team and with TFS Mpls/Tempe in order to meet and exceed partner expectations

Quality & Audit Rep Resume Examples & Samples

Conduct quality review for all Revenue Services staff. Generally, team will review five accounts weekly for each staff member and provide feedback to leaders and staff
Continuously review and suggest modifications to Quality tools to enhance reviews
Identify system wide quality improvement trends and coordinate with the Training Specialists and Revenue Services Leaders to develop new training materials
Monitor Revenue Services staff to ensure quality of work is consistent with best practices
Apply high level of knowledge in Revenue Services to complete quality review audits as it relates to Insurance Payer/Plan Selection, Billing and Follow-up, Cash Application, Transaction Processing, Technical Denials and Variances, Customer Service, Government Cost Analytics, and/or Vendor Management
Strong customer service skills
Excellent verbal and written communication skills (ability to communicate clearly and professionally)
Able to work in a fast paced environment
An interest in continuous process and quality improvement
Ability to travel on a weekly basis to other ministries or sites as needed
Billing regulations and workflows
Collections strategies
Denials review and root cause identification
Reimbursement analysis based on contracts
Cash posting and voucher review
Customer Service excellence utilizing A.I.D.E.T. and executing escalation process