Quality Assurance Compliance Lead
Resume:
Ka'Tasha Jones-
Williams
Quality Assurance & Compliance Lead
Smyrna, GA 30080, Smyrna, US, 30080
************@*****.***
Quality Assurance & Compliance Lead with extensive expertise in quality assurance and compliance in the healthcare sector, leveraging 19 years of experience to enhance patient safety and optimize healthcare delivery. Demonstrates strong leadership and communication skills, adept at implementing quality improvement methodologies and ensuring compliance with HIPAA standards. Passionate about embracing the latest healthcare technologies to deliver efficient and effective services while fostering continuous improvement and innovation.
Employment history
Nov 2023 - Present
QA - Quality Assurance & Compliance Lead (CQI)
Conduent at Remote
• Perform numerous testing procedures, including scripted, routine, and standardized.
• Maintain and develop internal support and call center quality assurance standards.
• Assess support interactions based on established quality standards.
• Accompany evaluations with meaningful and constructive feedback.
• Organized records and documents that describe the processes, procedures, standards of the company.
• Help the team improve agent performance with specific instructions and constant support.
• Map the need for training and onboarding programs and initiate these projects.
• Monitor customer service performance of the agent.
• Create reports that reflect support performance.
• Report on support team’s performance to upper management.
• Participate in calibration sessions to maintain consistency in internal evaluations.
• Regularly clean and maintain data to ensure accuracy and reliability.
• Provide administrative support and project management support for the Compliance program.
• Assist with review cycle of Compliance policies and procedures to ensure policies meet regulatory managed care requirements including NCQA standards.
• Create media to support learning (e.g., visual aids for face-to-face, various multimedia for e-learning and online).
• Develop assessments (including tests and/or surveys). Skills
Quality Assurance
Experienced
Compliance
Experienced
Healthcare
Experienced
Data Analysis
Skillful
Customer Service
Experienced
HIPAA
Experienced
Electronic Health Records
Experienced
Microsoft Office
Experienced
Salesforce
Experienced
Auditing
Experienced
Training
Experienced
Project Management
Beginner
Leadership
Expert
• Coordinate the development of Compliance material for the Client and Audit and Compliance subcommittee.
Aug 2020 - Nov 2023
Quality Compliance Specialist & Analyst / RCC Phone Services Client Advocate
SAGILITY (HUMANA) MEDICAID/MEDICARE at Remote
• Perform numerous testing procedures, including scripted, routine, and standardized.
• Maintain and develop internal support and call center quality assurance standards.
• Answer incoming calls from patients, healthcare providers, and insurance representatives, addressing inquiries, resolving complaints, and providing detailed information about medical services and procedures.
• Assist with scheduling, confirming, or modifying patient appointments with healthcare providers, ensuring efficient use of resources and adherence to scheduling protocols.
• Assist with filing grievances and appeals.
• Order medical and office supplies.
• Develop and implement office policies and procedures.
• Supervise office staff.
• Maintain medical and staff records.
• Ensure compliance with current healthcare regulations, medical laws and high ethical standards.
• CRM Software solutions (Salesforce).
• Research allegations from members of Sales Agents in the AIU dept.
• Listen to calls, read case files, investigate the allegations to determine a finding for the accused agent. (Verint).
• Write finals for leadership with details on calls, references.
• Ensure the agents function in a legal and ethical manner while meeting business goals.
• Developing compliance reports on agents, reviewing company policies, and including all findings in the reported allegations in the report.
• Skilled at rapidly mastering new software, methods, systems, procedures, and technologies.
• Managing and maintaining physical and digital records databases. Communication
Experienced
Problem Solving
Experienced
Attention to Detail
Experienced
Time Management
Experienced
Teamwork
Experienced
Adaptability
Experienced
Critical Thinking
Expert
Regulatory Knowledge
Process Improvement
Patient Advocacy
Languages
English
Native
Foster continuous improvement through regular coaching sessions, calibration meetings, and targeted feedback, driving team-wide excellence in compliance and quality.
Develop and implement new training programs and multimedia learning materials, addressing identified performance gaps and evolving regulatory requirements. Generate actionable performance reports for upper management, highlighting key metrics and trends to guide strategic decision-making in support operations. Meticulously review and update compliance policies, ensuring alignment with NCQA standards and regulatory managed care requirements across all support channels. Conduct comprehensive QA evaluations, leveraging data-driven insights to enhance customer service standards and agent performance across multiple channels.
• Ensuring accurate entry, indexing, and retrieval of documents.
• Implementing and overseeing document lifecycle procedures.
• Validating information submitted to systems for accuracy and accountability.
• Ensuring compliance with legal and regulatory requirements.Conducted comprehensive quality assurance testing, ensuring compliance with healthcare regulations and maintaining high ethical standards in Medicaid/Medicare operations. Apr 2015 - Aug 2020
Quality Control Asst. Supervisor, Analyst
Coach Communications at Auburn, AL
• Repetitive Testing.
• Develop and qualify new testing methods.
• Train other analysts to perform laboratory procedures, essays, and testing.
• Perform visual and dynamic inspections of incoming products and finished products.
• Participate in internal assessments and audits as required.
• Identify and troubleshoot equipment problems.
• Evaluate innovative technologies and methods to make recommendations regarding their use.
• Document quality assurance activities with internal reporting and audits.
• Develop improved standards for production and design and create testing protocols for implementation across all service lines.
• Identify training needs and take action to ensure companywide compliance. Jun 2013 - Mar 2014
QA Supervisor
CV HOLDING (HealthCare Manufacturing) at Auburn, AL Streamlined call center operations by developing internal support standards, resolving complex inquiries, and efficiently managing patient appointments.
Meticulously investigated sales agent allegations, analyzing case files and call recordings to produce detailed compliance reports for leadership. Implemented advanced document lifecycle procedures, enhancing record management efficiency while ensuring legal and regulatory compliance.
Fostered team synergy by supervising office staff, developing policies, and swiftly adapting to new software and systems to meet evolving business needs.
Conducted rigorous quality assurance testing for Medicaid/Medicare services, ensuring regulatory compliance and maintaining high ethical standards.
Identifying and resolving quality issues in the manufacturing process.Led quality assurance for diabetic healthcare products, implementing rigorous inspection protocols and enhancing production standards Streamlined quality control processes, significantly reducing defect rates and improving overall product reliability Mentored and trained quality control team, fostering a culture of excellence and continuous improvement in manufacturing operations Conducted comprehensive audits, identifying key areas for optimization and implementing data-driven solutions to enhance production efficiency
Developed and implemented new quality control systems, driving innovation in manufacturing processes and ensuring consistent product qualit
Led quality assurance for diabetic healthcare products, implementing rigorous inspection protocols and enhancing production standards Apr 2005 - Jan 2006
Quality Assurance (Healthcare Call Centre)
Aegis Communication at Port Saint Lucie, FL
• Provided feedback to improve performance and develop training programs for the agents who may need extra training.Conducted comprehensive audits of healthcare call center interactions, identifying key areas for improvement in customer service quality and compliance standards. Education
Oct 2022 - Nov 2024
Associate of Science in Allied Health Science
South University-Montgomery at Montgomery, AL & Savannah GA/Online Aug 1999 - May 2003
High School Diploma
Booker T. Washington High School at Tuskegee, AL
Additional information
Work Authorization
Authorized to work in the US for any employer.
Implemented targeted training programs based on performance metrics, leading to substantial enhancements in agent effectiveness and customer satisfaction rates.
Fostered a culture of quality by engaging team members in continuous improvement initiatives, resulting in more cohesive and efficient operations.
Meticulously analyzed call recordings and chat logs, providing actionable feedback to agents and contributing to the refinement of service protocols.
Developed and maintained comprehensive dashboards to track key compliance metrics, enabling data-driven decision-making and process optimization.
Conducted rigorous audits of healthcare call center interactions, identifying critical areas for service quality and compliance improvement.
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