Quality Scores
What is the number of calls QA audits monthly?
Unknown—could be anywhere from 0 to 7.
True or False
Four key points on scheduling calls may be skipped for any members that are familiar with the program.
True
What are the 3 exceptions to be able to provide both the first and last name?
KB0022205
Don’t you have all that information? You called me, you should know who you are talking to/calling for.”
“What is the full name of the person you are looking for? Are you looking for Robert Jr. or Sr.? Which Mr. Smith are you looking for?”
“This is Robert Smith. You are speaking with Robert Smith.” (And account lists first and last name as such.)
What is the introduction for Outbound calls?
Good morning/afternoon/evening. May I speak with Mr./Mrs. <member’s first or last name>, please?
Where can you locate your ACW in Genesys ?
Performance Tab
What 3 areas on the scorecard would be an auto fail?
Professionalism -10 pt
HIPAA Verification -10 pt
Legal/Client Scripting -10 pts
True or False
You must offer the TFN on each and every call.
False You must refer the member to HC communications for our TFN
True or False
It is okay to state the members phone number to a non-member?
False
Where can you locate the plan branding ?
Genesys and 3.0 box 1
Where should you check to see how much break and lunch time you have used?
Statuses
True or False
You can still get a 98% on your call if you miss reluctance.
False
Reluctance is worth 4 pts
True or False
Providing rewards card details is not required if a HouseCalls visit is already scheduled or if the member says they are familiar with the HouseCalls visit and they don't have any questions.
True
Would you need a complete address or full address for HIPAA verification?
Complete address is needed for HIPAA verification
A Full Address is needed for scheduled appt.
KB0022207
Which KB should be used to ensure proper HIPAA verification on an inbound call?
TeamCare HIPAA Verification Standards - Inbound HIPAA Verification
KB0022204
Your system crashed and you were unable to status or notate the member’s account. Where would you go to locate the member’s phone number?
Interactions
What are the 3 main categories of the scorecard?
Critical
Call Flow
Process
What is the note you would add on the additional notes field when a member does not have their PCP information?
Unable to collect PCP information
A non‑member answers the phone and asks what the call is regarding. You explain that you are calling to schedule Mrs. Davis’s HCV and mention that she would receive $50 loaded to her UCard this year. Would QA deducted points for HIPAA ?
Yes
When scheduling with a non‑member, what steps must you take, and which question should you ask?
Non Member process and Before we schedule, can you tell me the member’s preferred language for the appointment?”
What steps do you take to add a Personal Break so you can track your personal time?
Navigate to Statuses, click the plus sign (+) on the right side, open the Break dropdown, and select Personal Break.
What is the name of the app you can use to review your evaluations in?
Genesys Cloud
What KB shows exceptions for call handling?
KB0096399 Call Handling Process Exceptions
When would you ask the non member the HIPAA statement?
After verifying non member.
You ask the member how they would like to receive HC communication....by mail, email, or text. If text is already preselected, what should you do?
Confirm the mobile #
What is the organization name required to log into Genesys?
navihealth