Quality
What is the goal to meet for quality?
93%
Is Adherence included in QIP?
NO
if policy states will cover manual breast pump, member may purchase electric breast pump and pay the cost difference, what do you quote?
manual breast pump allowance only
What is your direct supervisor's full name?
Jamesetta Wilkins
The mother is not on the policy. She calls in and wants to update her son's DOB. It is okay. T/F?
False
Hold time MO will be assigned at what time mark (min)
5 min mark
I came in at 8:00, my first break is at 8:45. I am going to wait until 9:30 to go. Is this okay?
NO
What resources should you use to search for info.
FOLH, MBA Community, Emails. ask TTE, MPM
Name 2 supervisors in U500 team
Erica Alexander, Diane Murphy
Name 3 required pcs to validate HIPAA
ID or SSN
DOB 2 of 3 elements
grp #, grp name
address
What are the 2 components of quality that are audited?
Customer Experience and Technical
What is the ADH goal?
85% or higher
How many cost centers are there in U500? Name them
3 -7117 7123 7121
Who is Carrie Heard?
Operations Manager
The member ?d denied claim and doesn't know why the provider billed her. You show denied claim. What is next step?
Offer to call provider
What is the call closing wrap up?
Is there anything else I can assist with
For a good average of AU. You shouldn't use no more than how many minutes of personal time per day.
10min
I understand receiving a large bill can be alarming. I can definitely check the claims for you. What part of Ulysses is this?
Acknowledgment with I CAN
Name 4 other reps on your team of MVPs
Dominique, Jalecia, Sarah, Tesha, Rei, Kristina, Jackesha
It is not necessary to state the ID number out loud if the IVR shows it.
false
The member is getting a Provider Admin SPec Rx that requires a PA. How will provider obtain PA?
If your ACW time is reaching 5min + what should you do?
Notify a TTE to be placed in a more appropriate aux code
how many audits do you receive on average per month?
10
Who is Crystal Privett?
Director of Operations
Call not resolved is this an automatic failure?
YES