JOB PURPOSE: The Quality Support Specialist / Service Quality Specialist will manage various tasks related to service determination requests within a PACE organization. This role supports the SDR Unit, Interdisciplinary Team (IDT) and Care Delivery departments by ensuring accurate and timely documentation, effective communication with participants, and collaboration with various teams to process participant service data efficiently. JOB RESPONSIBILITIES: + Enter assessment and coordination notes into the EMR database (CareCompass) for participant orders related to home care services, supplies, nursing duty sheets, and other necessary data. + Conduct service determination calls to notify participants of the outcomes of their service requests, ensuring compliance with regulatory requirements and organizational policies. + Make follow-up calls to participants to confirm the implementation of services related to approved service determination requests (SDRs) and document outcomes in the EMR. + Perform quality validation calls to participants, providers, and home care agencies to confirm receipt of requested services. + Review participant requests submitted by PACE Service Coordinators and the Care Delivery department to ensure deliverables are received, customer satisfaction is achieved, and data is entered accurately and promptly. + Identify and correct any missing data submitted by PACE staff and communicate key updates to ensure timely delivery of services to participants. + Document any dissatisfaction with services expressed by participants or their caregivers for investigation and quality improvement purposes. + Enter and update daily service-related information required for the service coordination team's care planning to ensure consistent and reliable delivery of goods and services to participants. + Update Care Compass documentation related to the service determination request process, including requests, IDT reviews and assignments, determinations, coordination notes, participant notes, service orders, and service effectuation. + Manage escalated issues, disputes, and replacement requests as assigned on the worklist. + Provide general administrative support as needed. + Maintain departmental quality and productivity goals. + Adhere to all applicable compliance requirements and the Code of Conduct. Schedule: 8:30 AM – 5:30 PM Weekly Hours: 40 QUALIFICATIONS: Education: Associate degree preferred, or equivalent relevant customer service, quality, and auditing experience preferred. Experience: + Ability to pass a typing test with a minimum speed of 45 WPM. + One to two (1-2) years of experience in customer service, quality, and/or auditing. + Excellent written and verbal communication skills. + Ability to thrive in a fast-paced environment and meet assigned deadlines. + Strong organizational skills, accuracy, and attention to detail. + Ability to work both independently and collaboratively as required. + Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook. Physical Requirements Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to: + Standing – Duration of up to 6 hours a day. + Sitting/Stationary Positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods. + Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc. + Bending/Squatting – Have to be able to safely bend or squat to perform the essential functions under the scope of the job. + Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas. + Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.) + Sight/Visual Requirements – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy. + Audio Hearing and Motor Skills (Language) Requirements – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual. + Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job. Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company. We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Salary Range (Min-Max):$45,000.00 - $50,000.00