Quality Management Auditor and Compliance Specialist

Ruthie Vuittonet

**** ****** **. ** ******, GA 916-***-**** **********@*****.***

Objective

A position that will offer opportunities for professional growth, knowledge and advancement. Experience

07/16/2019 – 01/04/2023 Denti-Cal State Government Program Rancho Cordova, CA Quality Management Auditor

● Produces Daily, Weekly, and Monthly reports in accordance with schedule and DLP

● Follows up on all Error Findings for correction and resolution

● Monitors and evaluates calls for soft-skills, customer experience, as well as reviewing compliance with rules and regulations of the organization

● Audits and scores a percentage of calls and/or transactions based on call volumes for customer service and transactions completed within enrollment and billing, for accuracy of information, and efficiency

● Prepares and analyzes internal and external quality reports to make recommendations to leadership

● Communicates with the trainer to update, develop, evaluate, validate, and maintain training materials for best practices surrounding soft skills, HIPPA accordance, insurance verification, etc

● Collaborates with data suppliers and management team to understand and improve the accuracy (“calibrate”) of quality monitoring information and tools

● Holds regular calibration meetings with D2C Supervisors to align QA efforts of Customer Service Reps and Enrollment and Billing team members

● Interacts frequently with Customer Experience representatives to formulate corresponding D2C initiatives

● Alerts D2C Supervisors to constructive feedback and improvement opportunities for underperforming Customer Service Reps

● Completes Quality Review of Enrollment Manual and Electronic Updates /Processes and document findings

● Completes Quality Review of Billing Configuration Updates and document findings.

● Completes Quality Review of Billing Reconciliation and Accounts Receivable and document findings

Experience

3/14/05- 07/16/2019 Denti-Cal State Government Program Rancho Cordova, CA Fair Hearing Analyst/ Customer Service

● Assisted in expediting all Spanish speaking cases within and without the Department

● Reviewed reports/ cases daily to meet Department production

● Audits high confidential documents

● Investigated and resolved outstanding cases, created resolution letters

● Responded to request(s) by customers and providers in a professional and positive manner

● Handled various databases and sub-systems

● Researched hearing request(s) and obtained additional information

● Analyzed documentation and makes a determination on how to proceed to provide case reevaluation

● Created judicial documentation supporting the determination including letters, Addendums and Position Statements

● Processed Claims and Treatment of Authorizations based on the final determination References: Available upon request

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