Investigator Utility Bill Complaints Job Description Sample
Manager, Post Market Complaints
Monitor and manage post market surveillance activities such as complaint and incident reporting. Manage the Escalated Complaint Team (ECT) project managers to ensure timely and accurate processing of escalated complaints.
This includes the investigation of product malfunctions, product design and/or labeling questions, as well as customer dissatisfaction issues, and the regular monitoring and reporting of complaint handling status. Monitors metrics and drives process improvements based on performance trends.
Ensure proper analysis of product quality, safety, and reliability issues and effective communication to management and other functions. Initiate and facilitate corrective or preventative actions as needed. Ensure quality customer and regulatory communications for current products.
Contribute to Post Market Surveillance and Complaint Handling process requirements, including SOPs and Work Instructions, that ensure compliance with evolving Global Requirements and Regulations such as the EUMDR.
This role requires working with and through appropriate in-country and out-of-country corporate and business operational functions, leading cross-functional efforts to ensure the Company's complaint handling process. This role works closely with cross-functional teams, including - Engineering, Risk Management, Product Management, Manufacturing, Customer Support and Quality Assurance to ensure the correct information is gathered and acted upon.
Contribute to continuous improvements to Complaint Handling process
Provides timely Global Adverse Event reporting.
Facilitate the progress of complaints throughout the complaint lifecycle to ensure proper documentation and timely closure of each complaint
Collaborate with Customer Support, Engineering, and Service teams to support complaint activities
Generate Global complaint trending reports for analysis
Support and participate in internal and external audits
Assist in generating Global complaint data reports for QRB and Management Review Meetings
Develop and maintain product knowledge of existing and new products
Provides routine metrics/analysis monthly and quarterly.
Provide feedback/direction to ECT members.
Provide responses to Regulatory Authorities.
Provides feedback to the post market Risk Analysis process.
Provides input on ECT procedures and process improvements.
Works closely with the Director, Post Market Surveillance to establish Quality Performance Metrics and Complaint Reports, analyzes quality data to identify tends and reports them to management in a timely fashion.
Supports the Corporate Corrective & Preventative Actions (CAPA) program, with particular emphasis on CAPAs escalated from Complaints.
Perform reportability determinations in conjunction with medical advisor as necessary.
Lead Complaint Handling Unit and cross functional team of individuals through completion of investigation and closure of reportable and non-reportable product complaints in accordance with established company procedures and worldwide regulations and standards.
The role requires awareness of new or revised regulations and/or guidelines.
Reviews and continuously leads efforts to improve the global complaint handling and post market surveillance processes.
Authors and approves response communications to inquiries from regulators.
Supports internal and external audits (e.g. FDA) of complaint handling function.
Serve as a backroom subject matter expert (SME) for complaint processing, complaint investigation and MDR reporting during audits and inspections.
Provides management direction, motivation, and support for personnel. Provides leadership to complaint handling staff to ensure complaint files are processed in a uniform and timely manner.
Direct experience handling complaints in the medical device industry.
Can work on assignments of diverse scope; work independently on most tasks, with limited direction.
Ability to exercises judgment to make decisions for less defined issues and selects methods and techniques for obtaining solutions.
Strong organizational and time management skills.
Ability to review, analyze, summarize, and interpret data; draw conclusions and make appropriate recommendations and decisions.
Strong influence management skills.
Excellent communication skills, both oral and written.
Detailed knowledge of the FDA regulations as they apply to medical device companies.
Intermediate to Advanced Excel skills.
Ability to communicate appropriately across functions and at all levels.
Ability to work with geographically diverse and international teams
Other Desired Skills and Knowledge
Strong knowledge of Radiation Therapy products.
Regulatory Affairs Certificate (RAC).
General knowledge of mechanical, electrical and software development practices
Proficient in utilizing business tools such as: E-mail, Microsoft Word, Excel, and PowerPoint, EtQ, SharePoint, ClearQuest, Quality Center, Salesforce
Sr. QA Associate, Product Complaints
Developing innovative therapies is one of the most challenging, most essential and personally rewarding fields in science. This is the most exciting time to be a part of Astellas, a company with a uniquely collaborative and patient-focused culture.
There's something special about working at Astellas. It's reflected in our focus on the people we serve, the way we treat each other and the results we achieve together as a company.
Astellas is announcing a Sr. QA Associate, Product Complaints opportunity in Northbrook, IL.
Purpose & Scope:
Executes tasks associated with Product Complaints, following sufficient management oversight/guidance. Maintains applicable databases and assists with the collection of metrics. Assures Astellas and vendor compliance with Federal Regulations, Corporate standards and associated SOPs. Triages the Product Complaints inbox on a routine basis to ensure compliance, and elevates potential Field Alerts (FAR) to senior management within 3 days, if a significant product complaint is received that could impact patient safety.
Essential Job Responsibilities:
Executes tasks associated with Quality Systems and applicable databases as an individual contributor, which includes collecting and classifying information appropriately. Updates related databases (e.g. TrackWise) in a timely manner. Generates status reports (e.g. reconciliation, monthly reports) as required, and maintains the database in a compliant manner.
Subject Matter Expert (SME) in Product Complaints and the necessary TrackWise workflows.
Utilizes technical skills and tools effectively to identify issues, evaluate risk and facilitate appropriate solutions to management.
Coordinates the collection and tabulation of metrics related to the Quality Systems, as directed by their supervisor and/or Product Complaints Manager.
Assures AUST QA and vendor compliance to corporate policies, SOPs and Regulatory agency standards. Identifies issues, communicates them promptly and initiates corrective action as directed.
Assists in the coordination of Product Recalls and Regulatory Agency inspections, as necessary.
Collaborates with departmental and cross-functional teams to address cGMP compliance issues and process improvement initiatives. Completes projects on-time and as assigned.
Responsible for the storage and maintenance of departmental forms (hard copy and electronic) and product specific Retain samples (e.g. Tarceva).
Authors, revises and performs maintenance and administration of departmental controlled documents (i.e., SOPS, WPDs, STLs, etc.) as necessary.
Executes the required tasks associated with the AUST QA Product Complaints function, with an emphasis on compliance to product complaint handling. Responsibilities include complaint receipt, processing, investigation review and customer response.
This role reports to the Senior Director, PQM -- AMR. This person works closely with other areas such as Medical Information, Pharmacovigilance, PPM, RA, Supply Chain, QAE and QAJA.
1.Minimum of a BA/BS with 3 years of industry experience with a minimum of one (1) year of QA experience.
2.Knowledge of cGMPs and other industry regulations.
3.Effective communication and interpersonal skills, ability to ensure team success as an individual contributor, attention to detail and the ability to understand current trends of industry standards relating to Product Complaints handling.
4.Must be able to represent the company to external stakeholders, including healthcare professionals.
5.Requires experience with Information Management Systems to log, track and trend applicable Quality Systems.
6.Demonstrated experience and proficiency in all areas of Product Complaint handling and compliance.
7.Executes assigned tasks with sufficient management oversight/guidance.
1.Previous experience in Product Complaint handling and associated regulatory compliance desired.
2.Proficient in Trackwise and Documentum.
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Associate Director, Complaints And Non-Conformance Process
model - Growth Pharma. Allergan is focused on developing, manufacturing and commercializing branded pharmaceutical, device, biologic, surgical and regenerative medicine products for patients around the world.
Allergan markets a portfolio of leading brands and best-in-class products for the central nervous system, eye care, medical aesthetics and dermatology, gastroenterology, women's health, urology and anti-infective therapeutic categories. With commercial operations in approximately 100 countries, Allergan is committed to working with physicians, healthcare providers and patients to deliver innovative and meaningful treatments that help people around the world live longer, healthier lives every day.
Allergan is a company that will inspire you to aim high with your ambition. Where you can build bridges all over the world. Where you can power ideas that drive change. And where you will act fast and drive results for customers and patients. Power your future & join our bold team.
The Associate Director, Product Release and Investigations manages the personnel and processes responsible for customer product complaints, investigations of deviations and the associated trending program at the Waco facility.
Main Areas of Responsibilities
This position is responsible for:
Lead the Customer Complaint and Non-Conformance group in Waco facility.
Perform trending activities and present mitigation CAPAs to Quality Leadership
Perform monthly reviews for both complaints and NC program
Define priorities and responsibilities among the team.
Oversees customer complaints and ensures emerging issues are elevated appropriately to protect patient safety
Evaluate and approve consumer complaints by preparing written investigations, evaluations, and responses to customer complaints to identify root causes, develop mitigation, and remediation plans.
Ensure that complaint trends and statistical evaluations relating to customer complaints from sources (e.g., the complaint database, non-conformances, and preventative maintenance data) are performed according to procedures and industry standards.
Evaluate preventative and proactive identification of variables to provide data for decisions and preventing customer complaints.
Collaborate with Production and Engineering to ensure complaint trends and serve as the QA representative to implement corrective and preventative actions.
Serve as the QA liaison for Global Safety to initiate HEE's.
Responsible to keep ongoing communications with different global and regional areas regarding complaint investigations, corrective, and preventative actions for customer complaints.
Serve as the QA representative to review and approve Non-Conformances.
Generate appropriate CAPA's and/or provide guidance regarding Quality Defects or Patient Safety
Support change control activities associated with processes and equipment regarding Quality Defects or Patient Safety
Manages reporting and documentation systems for regulatory compliance, such as traceability reports, distribution reports, Quality Indicators reports, and monthly/quarterly metrics reporting.
Interfaces/communicates as required with Logistics and Distribution groups.
Incumbent must be self-directing and has full authority to make decisions and/or take action that is required to carry out job duties. Allergan internal requirements include compliance with ethics, environmental health and safety, financial, human resources, cGMP procedures, general business policies, requirements and objectives. The incumbent must be willing to take temporary assignments as required. Incumbent is responsible for ensuring site leadership is made aware of critical issues.
Allergan is a regulated company and the incumbent is expected to be fully compliant with all criteria established by governmental agencies, Ministry of Health, and legislative requirements including, but not limited to: the FDA, European Community (EC), ISO 13485 - Medical Devices, European Economic Community Medical Device Directive (MDD), Canadian Medical Device Regulations (CMDR), OSHA, Sarbanes-Oxley, EPA, DOT, EEOC, and ADA.
Incumbent will work to ensure that the company is in compliance with all environmental, health and safety requirements and assure our business practices enhance the welfare of our customers, employees and the community in which we operate.
The following listed requirements need to be met at a minimum level to be considered for the job:
Minimum requirements for this position are:
A minimum of ten (10) years of experience in a Quality Operations role.
A minimum of six (6) years of experience in a Quality position involving one of these areas: Customer Complaints, Non-Conformances, Disposition, and/or Quality Laboratories and Systems.
A minimum of six (6) years in the medical device or pharmaceutical industry.
Strong user of Excel and Statistical programs like Minitab. Proficient in Microsoft Office (Word/Excel) and functional user experience with SAP preferred.
Experience working in a GMP regulated environment.
The below skills are attributes that may not be mandatory but are definitely desired in the ideal candidate.
Experience working in an Aseptic Production environment preferred.
Excellent verbal and written communication skills.
Detail-oriented and self-motivated.
Excellent organization skills.
Ability to manage multiple tasks and teams.
Will interact with all functional departments within the company including hourly, professional and management personnel.
Must have GMP experience in an FDA related environment, inclusive of 21 CFR Part 11 compliance criteria.
Working knowledge of Quality Assurance systems and cGMPs, ISO13485, CMDRs, and CFRs and EMEA regulations.
- A Bachelor's degree in Engineering, Statistics, Sciences or a related discipline. A graduate degree is preferred.
Site QA Complaints Coordinator - Sturgis, MI Plant (1St Shift)
At Abbott, we're committed to helping people live their best possible life through the power of health. For more than 125 years, we've brought new products and technologies to the world -- in nutrition, diagnostics, medical devices and branded generic pharmaceuticals -- that create more possibilities for more people at all stages of life. Today, 99,000 of us are working to help people live not just longer, but better, in the more than 150 countries we serve.
Primary Function/Primary Goals/Objectives:
The function of the Site QA Complaints Coordinator for Sturgis Quality Assurance is to coordinate product improvement efforts through investigation of customer complaints. The complaints recorded are for adult nutritional, pediatric nutritional and Third Party Manufactured (TPM) products and are received from the United States, Canada and International affiliates worldwide. The objective of the Site QA Complaints Coordinator is to collect, investigate and report complaint information so that corrective actions can be initiated and implemented to improve our products for our customers. Through this process, loss in sales and market share can be prevented. To reach this objective, the Site QA Complaints Coordinator manages:
Effective communication with Corporate, Division and Operations/QA Management
Good working relationship with site QA Project Leader and Quality Engineers
Complaint information provided by the Abbott Nutrition Complaint Handling Unit
Potential high impact complaints where a potential broader issue is identified
Physical sample evaluation (field/reference)
Batch Record Reviews (BRR)
Coordination and distribution of investigations to the subject matter experts (SME)
Timeliness by maintaining and tracking Plant Investigations via the site tracking system
Periodic examination of process and/or equipment operations
Compiled data returned by the SME's
Good planning, prioritizing and organizational skills
Good communication skills (oral and written)
Adaptability due to urgent requests (FDA, etc.)
CAPA investigations for complaints (Initiation – Event Owner)
Return of "publication ready" information to the Complaint Handling Unit database for the complaint file
Completed Plant Investigation files/records
CAPA related projects relevant to complaint investigations
Special project requests from various levels throughout the organization
Job Aid for site BRR navigation system, Division Complaint Handling Unit website and conducting a comprehensive BRR
Contract personnel with directions/instructions related to complaints
One QS batch auditor (BRR back-up) with directions/instructions related to complaints
Meetings with contract personnel and QS batch auditor to communicate any new changes, etc.
A positive attitude
Additional work hours, if necessary
Complaint files are handled in accordance with FDA regulations and Corporate and Division Quality Assurance policies and procedures.
Responsible for implementing and maintaining effectiveness of the Quality System
Coordinates the complaint investigation process for the Sturgis plant in compliance with FDA Regulations and Abbott policies and procedures
Reviews batch records, complaint investigations, physical samples and trend evaluation for inclusion of appropriate documentation in the investigation of the complaint
Issues weekly status reports to appropriate plant management to assure efficient turn around of investigations
Notifies appropriate management (plant and division) of noted trends
Assure results of the BRR and investigation information is entered accurately into the Complaint Handling Unit database within the prescribed timeframes
The position requires the ability to plan, understand often complex complaint issues, coordinate with other professionals and make appropriate decisions to solve problems and gather necessary information
Sound judgment is required to determine the adequacy of the complaint investigations
Oversees and assists in directing the workflow of one contract personnel whose work solely resides around the completion of batch record reviews
- Bachelor's Degree preferred
- OR A combination of 2 yrs manufacturing experience with 2 yrs Quality Assurance experience
- OR 4 yrs total Quality Assurance experience
- LACF (Low Acid Canned Foods) Certified
Knowledge of applicable regulatory standards and requirements for infant formula and nutritionals
Ability to think independently to solve problems and trouble shoot problems expeditiously
Knowledge of FDA regulations including the IFA (Infant Formula Act), LACF (Low Acid Canned Foods) and cGMP (Current Good Manufacturing Practices)
Knowledge of corporate and division policies and procedures for complaint handling as well as other pertinent procedures
Ability to give effective oral presentations to various plant and divisional groups
Ability to handle large volumes of work to juggle multiple tasks simultaneously
Knowledge and understanding of various computer programs including Excel, Access, ABTRAQ, TeamCenter, Zarpac, Plant TV, QualTrend and specifically the Abbott Nutrition Complaint Handling database
The ability to create, manipulate and manage databases
Knowledge of the batch record, Division Complaint Handling Unit applications and processes involved
Knowledge of all products manufactured by the Sturgis site
Knowledge of stock codes, defect codes and batch codes
The complaint area is an area of high regulatory exposure. A properly handled complaint may restore customer loyalty while an improperly handled complaint may mean loss of business, litigation, adverse media attention or a product recall. With the numerous sources of information needed to be reviewed in the complaint handling process, and the high volume of complaints reported for the Sturgis site, there is a high risk for potential error to occur. This position requires meticulous attention to detail to minimize that risk for error. If an error isn't caught and is found by FDA, Corporate, Division or Third-Party auditors, the outcome could be observations or field actions
There is high degree of autonomy, independent thinking and self-sufficiency required in the performance of the job
The job has target dates and daily responsibilities that are required to be met for the smooth continual operation of the Quality Assurance department. It is the individual's responsibility to meet those dates.
Supervision/Management is provided for training, direction in handling unusual events and in guidance for special projects requested by upper management
JOB FAMILY:Operations Quality
DIVISION:ANSC Nutrition Supply Chain
LOCATION:United States > Sturgis : Building 01A
SIGNIFICANT WORK ACTIVITIES:Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day), Continuous standing for prolonged periods (more than 2 consecutive hours in an 8 hour day), Continuous walking for prolonged periods (more than 2 hours at a time in an 8 hour day)
Abbott is an Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans.
EEO is the Law link
- English: http://webstorage.abbott.com/common/External/EEO_English.pdf
EEO is the Law link
- Espanol: http://webstorage.abbott.com/common/External/EEO_Spanish.pdf
QA Complaints Specialist
QA Complaints SpecialistOntario CA.
Thrive on innovation at a global technology leader. Develop exciting solutions in a diverse, stable work environment that's focused on the future. Join us in a modern work environment with an open and inspiring culture and colleagues!
To strengthen our Team , we are seeking a/an
To assist in maintaining Quality Assurance and Control practices in adherence to the Food and Drug Administration (FDA) regulations for the Quality System Regulation and for ISO 13485 standards, the QA Specialist is responsible for managing complaint handling, returned goods tracking and reporting requirements. The QA Specialist will be responsible for working with Engineering, Manufacturing and Quality Assurance to coordinate the activities required for investigation including failure analysis, nonconformance and CAPA related to complaints. The position requires reporting returns to regulatory agencies as required and close investigations within appropriate timeframes.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
Evaluate, investigate, and resolve complaints while also analyzing complaint data and gathering additional information as needed.
Manage the complaint investigation process end-to-end.
Work with other teams in a collaborative environment to complete the end-to-end complaints process in a highly regulated environment.
Document product return and/or complaints as well as the results of investigations in a timely manner.
Interface with customers and internal employees for reporting of complaints and returned goods.
Document the analyses of product complaints for trends and identification of potential corrective or preventive actions.
Report product complaints to appropriate regulatory agencies as required.
Serve as a member of the internal audit team and implement/assist in implementing corrective and preventive actions.
Recommend improvements in quality system to ensure that the quality system is efficient and effective controls are in place to minimize risk.
Complete projects in a timely manner and consistent with corporate objectives.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
EDUCATION and/or EXPERIENCE
H.S. Diploma with 3+ years relevant related experience
Bachelor's degree in engineering, clinical sciences, related sciences is preferred.
1+ year of post-market complaints experience in a medically regulated industry with an understanding of appropriate global medical device regulations, requirements, and standards such as ISO 13485 and FDA QSR.
Medical Device and or other regulated industry (Pharma, IVD,) preferred.
Must be able to work as a team to gather information needed to understand and solve problems
Experience in Technical Writing
Experience with creation and writing procedures or policies
Advanced computer skills preferred
Quality Management software knowledge preferred
We are an EEO/AA/Veterans/Disabled employer.
Carl Zeiss Meditec, Inc.
At ZEISS we encourage creative thinking and innovation. We work in dynamic and interdisciplinary teams and offer individual development perspectives as well as flexibility in organizing your work. We care about our employees and take particular responsibility for improving society and preserving our environment. These core values have shaped our corporate culture at ZEISS for over 170 years.
Help us shape the future!
The application process takes less than 10 minutes, we look forward to receiving your application.
Bill Of Materials Coordinator
Are you moving forward?
Valmet is the leading global developer and supplier of process technologies, automation and services for the pulp, paper and energy industries. Valmet's net sales in 2017 were over 3 billion Euro. Be part of a global team supporting our customers who convert renewable resources into recyclable products in a highly sustainable way.
Valmet is seeking great people to mentor into the next generation of paper industry professionals. Help us remain champions to our customers while being good neighbors and stewards of the earth reducing our impact to the environment. Your future is bright at Valmet.
Do you enjoy problem solving and working with technical systems, components, and machine controls? Be part of a team that helps identify replacement parts and controls for large-scale industrial equipment within the pulp & paper industry.
Your expertise means that a paper machine the length of a football field can continue to operate at optimum efficiency. You will research, develop and/or correct structured Bills of Materials to support our service industry. For your basic tools you’ll process within our engineering database and our ERP / business system.
The right candidate will have a technical-based Associate’s or Bachelor’s degree or related experience, ideally in an industrial environment. Valmet employees enjoy a competitive wage and a benefits package that includes a company funded pension plan, 401k with company match. Our working environment is team-orientated, international and focused on growth.
Associate, Client Complaints Specialist
West Creek 5 (12075), United States of America, Richmond, Virginia
At Capital One, we're building a leading information-based technology company. Still founder-led by Chairman and Chief Executive Officer Richard Fairbank, Capital One is on a mission to help our customers succeed by bringing ingenuity, simplicity, and humanity to banking. We measure our efforts by the success our customers enjoy and the advocacy they exhibit. We are succeeding because they are succeeding.
Guided by our shared values, we thrive in an environment where collaboration and openness are valued. We believe that innovation is powered by perspective and that teamwork and respect for each other lead to superior results. We elevate each other and obsess about doing the right thing. Our associates serve with humility and a deep respect for their responsibility in helping our customers achieve their goals and realize their dreams. Together, we are on a quest to change banking for good.
Associate, Client Complaints Specialist
The Commercial Operations team supports our clients and client bankers to set up relationships and provide ongoing servicing support.
The Commercial Operations Complaints Specialist is responsible for conducting quality assurance of captured complaints and customer calls monitoring for a breach of bank policy or regulatory policy. This role will support all commercial lines of business to manage adherence to internal policies and procedures and take care of our clients. The right candidate will have excellent oral and written communication skills. They must have the ability to work autonomously, cross-site, and effectively partner with various internal groups when supporting complaint research and documentation efforts.
Quality Assurance of captured complaints
Quality Assurance of prerecorded customer calls to internal associates
Updating trackers, inputting Tier 3 complaint information into Chordiant,
Maintaining accurate files for Tier 2 escalations and Tier 3 complaints
Additional project requests as needed.
Possess a strong understanding of regulations and internal business practices, ensuring these are adhered to.
Look for opportunities to identify on-going issues and eliminate repeat complaints to improve our overall customer experience.
Make positive contributions to the development of overall complaint processes
High School Diploma, GED, or Military experience
At least 1 year of experience with Microsoft Office or Google Suite
At least 1 year of experience in Commercial, Risk Management, or Compliance
Bachelor's Degree or Military experience
At least 1 year of experience in Quality Assurance
At least 1 year of experience in Treasury Management
At least 1 year of experience in Salesforce
At least 1 year of experience in Chordiant case management system
BPM (Business Process Management), Lean, or Six Sigma certified
At this time, Capital One will not sponsor a new applicant for employment authorization for this position.
Medicare Unit Supervisor - Patient Financial Services (Pat Bill AND Coll Supv 2)
At UCSF Health, our mission of innovative patient care, advanced technology and pioneering research is redefining what's possible for the patients we serve – a promise we share with the professionals who make up our team.
Ranked by U.S. News & World Report as the number one hospital in California – and among the top six in the country – UCSF Health is committed to providing the most rewarding work experience while delivering the best care available anywhere. In an environment that allows for continuous learning and opportunities for professional growth, UCSF Health offers the ideal atmosphere in which to best use your skills and talents.
Involves patient, third party, government, physician billing and / or collections activities. Provides for coordinated processes, procedures and systems, customer service delivery models and ensuring compliance with internal policy and external agency regulations. Manages insurance reimbursement from third-party billings and government insurance programs.
Keeps abreast of the full array of third-party contracts and billing / collections requirements. Incorporates cash posting, accounts receivable management and financial counseling for securing collections of accounts.
Minimum one to three years experience in a hospital billing office environment
High School diploma or equivalent experience
Previous supervisory experience
Demonstrated supervisory, organizational, and customer service skills to effectively supervise and prioritize the activities of subordinate staff, and to manage the complex workflow and multiple priorities involved with billing and / or collections operations
Thorough knowledge of medical and insurance terminology, and of billing and / or collections internal procedures and external regulations; demonstrate an in depth understanding of all aspects of Medicare and Medicare Advantage billing and collections rules and regulations; demonstrate a general understanding of all aspects of Medi-Cal/CCS/Medi-Cal Managed Care billing and collection rules and regulations; an in-depth knowledge of compliance and applicable local, county, state and federal regulations
Solid knowledge of human resources management policies, with the ability to evaluate and document human resources matters and performance
Strong skills in quality customer service. Interpersonal skills to manage conflict and collaborate effectively with all constituent groups, including patients, physician offices, third-party payors, attorneys, outside agencies, and clinical and administrative personnel across departments; ability to balance assertiveness with compassion for the patient and others
Solid leadership skills to coach and improve staff performance; ability to provide thorough and accurate review of complex subordinate work and to oversee coordination of ongoing tasks and projects over extended periods of time
Skilled in written and verbal communications, with the ability to serve as a resource, to convey complex clinical finance and business information in a clear and concise manner, and to prepare and present a variety of reports and analyses
Computer proficiency in all relevant hardware, software, and specialty information systems used throughout the department. Ability to synthesize data and utilize computerized systems to produce meaningful reports on department operations. Computer software skills (Microsoft Word, Excel, Access, Power Point, E-mail, etc.)
Strong critical thinking skills, with the ability to quickly analyze and evaluate complex and difficult problems, determine appropriate level of intervention, and develop and apply solutions; proactive and assertive account resolution skills
Medical terminology experience
ICD, CPT4, HCPCS, DRG coding experience
Knowledge of electronic billing systems (i.e. NEIC, Cirius, WebMD, Envoy, etc.)
The flexibility to orient and work at all UCSF Medical Center locations
- Bachelor's Degree in related area and / or equivalent experience / training
Living Pride Standards
Demonstrates service excellence by following the Everyday PRIDE Guide with the UCSF Medical Center standards and expectations for communication and behavior. These standards and expectations convey specific behavior associated with the Medical Center's values: Professionalism, Respect, Integrity, Diversity and Excellence, and provide guidance on how we communicate with patients, visitors, faculty, staff, and students, virtually everyone, every day and with every encounter. These standards include, but are not limited to: personal appearance, acknowledging and greeting all patients and families, introductions using AIDET, managing up, service recovery, managing delays and expectations, phone standards, electronic communication, team work, cultural sensitivity and competency.
Uses effective communication skills with patients and staff; demonstrates proper telephone techniques and etiquette; acts as an escort to any patient or family member needing directions; shows sensitivity to differences of culture; demonstrates a positive and supportive manner in which patients / families/ colleagues perceive interactions as positive and supportive. Exhibits team work skills to positively acknowledge and recognize other colleagues, and uses personal experiences to model and teach Living PRIDE standards.
Exhibits tact and professionalism in difficult situations according to PRIDE Values and Practices
Demonstrates an understanding of and adheres to privacy, confidentiality, and security policies and procedures related to Protected Health Information (PHI) or other sensitive and personal information.
Demonstrates an understanding of and adheres to safety and infection control policies and procedures.
Assumes accountability for improving quality metrics associated with department/unit and meeting organizational/departmental targets.
Keeps working areas neat, orderly and clutter-free, including the hallways. Adheres to cleaning processes and puts things back where they belong. Removes and reports broken equipment and furniture.
Picks up and disposes of any litter found throughout entire facility.
Posts flyers and posters in designated areas only; does not post on walls, doors or windows.
Knows where the Environment of Care Manual is kept in department; corrects or reports unsafe conditions to the appropriate departments.
Protects the physical environment and equipment from damage and theft.
The flexibility to orient and work at all UCSF Medical Center locations is required.
Equal Employment Opportunity
The University of California San Francisco is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Further information about the University of California, San Francisco, is available at diversity.ucsf.edu. UCSF seeks candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence, and the communities we serve.
Bill Review Team Lead - Rancho Cordova CA
Bill Review Team Lead
IF YOU CARE, THERE'S A PLACE FOR YOU HERE
For a career path that is both challenging and rewarding, join Sedgwick's talented team of 21,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets -- their employees, their customers and their property. At Sedgwick, caring counts®. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.
PRIMARY PURPOSE: To supervise expense bill reviewers in needs assessment and implementation of timely cost-effective fee management services in compliance with corporate/jurisdictional standards; to provide review of technical, complex claims requiring extensive skills/experience; and to interact with expense bill reviewers, utilization review nurses, and claims staff to resolve problems and/or implement and improve workflow and communication.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Performs senior position duties, including one or more of the following: train expense bill reviewers; organize and assign workload; monitor performance; manage performance reviews; and assist with complex bill reviews.
Reviews and maintains standards of turnaround expectation, customer satisfaction expectations.
Works directly with reviewers to assure effective results through skilled, efficient services.
Maintains knowledge and familiarity with corporate quality standards; ensures consistent application.
Assures maintenance of productivity standards within acceptable error rate.
Reviews bills using experience-gained knowledge of fee schedule and medical terminology; maintains knowledge of all bills regardless of complexity of claims, levels of service, or multiple jurisdictions.
Ensures good results to our customers; provides quality customer service in oral and/or written communication.
Develops and maintains tracking and quality assurance reports; obtains and reviews operational reports; and develops and implements operational revisions as necessary to improve service or unit efficiency.
Acts as liaison between claims staff, nursing staff, medical bill payment team, and expense bill reviewers.
Responds to written or verbal requests from vendors, insurance carriers, legal representatives, and injured workers by preparing documentation; may assist in preparing case testimony.
Assists in maintaining customer relationships from a technical perspective; assists sales process/customer tours as necessary.
Works with program manager, claims unit, expense bill reviewers to resolve questions, redesign workflow, and ensure efficient, accurate bills processing.
Participates in group meetings and training sessions.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
Provides support, guidance, leadership and motivation to promote maximum performance.
Education & Licensing
Baccalaureate degree from an accredited college or university preferred.
Five (5) years experience in workers compensation claims processes with experience in state regulatory issues for payment of expense bills required.
Skills & Knowledge
Knowledge of legislative environment and the market place
Good customer service skills
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer
Farm Bill Technician Aide
Farm Bill Technician Aide
HS/GED Degree OR Minimum of 5 year(s) of experience in related to position
Valid Driver's License.
Experience required with Windows, Copying Machine, MS Word, MS Excel
Database, Agency Specific; Business Machines, Telephone
Assist the Area and Field Offices with program support activities in the
implementation of resource management and conservation planning.
Provide technical and administrative support to deliver conservation
planning efforts to landowners participating in USDA Farm Bill programs. Duties
include conservation planning and application assistance, ranking criteria,
payment document preparation and submittal, and filing. Other duties as
Assist with practice applications. Duties include field investigations,
topographic site surveying, practice analysis and design, layout, construction
inspection, status reviews, and development of as built plans. 30%
Assist NRCS employees with activities that supports the implementation of
Farm Bill programs. Duties include typing, copying, editing, and mailing
documents. Case file management, prepare files, scanning, analyzing data,
developing tracking methods, and other electronic files. 20%
Communicates orally and in writing. Communicates with managers, employees,
and the public. Prepares letters, reports, and email communications. 20%
Mandatory USDA Computer Security Awareness and Freedom of
Information/Privacy Act Training.
Incumbent will be trained on Natural Resources Conservation Service (NRCS)
software, such as but not limited to, Protracts, Toolkit and Performance Results
Overnight travel: Overnight travel will be rare, but may need to drive a
Government vehicle on occasion.
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