QA Analyst - Patient Support

Quality Monitoring & Evaluation

- Monitor and evaluate recorded and/or live patient support interactions, case documentation, and related workflow activity using approved scorecards and client/program standards.

- Assess the accuracy and completeness of information provided regarding copays, deductibles, coinsurance, out-of-pocket responsibilities, eligibility, benefit verification, copay programs, and other assigned patient-support topics.

- Evaluate pharmacy claim-support activity for adherence to established procedures, including common rejections, refill-too-soon issues, coordination of benefits, prior authorization status support, plan limitations, and appropriate escalation.

- Evaluate patient identity verification, HIPAA/privacy practices, required scripting or disclosures, documentation quality, professionalism, empathy, and adherence to call and case-handling procedures.

- Promptly escalate critical errors, compliance or privacy concerns, patient-safety concerns, and material process deviations through established channels.

Calibration, Feedback & Continuous Improvement

- Participate in regular calibration sessions with Quality, Operations, Training, and other stakeholders to promote consistent scoring and interpretation of standards.

- Provide clear, objective, documented feedback identifying strengths, errors, and improvement opportunities for leader coaching and development.

- Analyze recurring quality trends, error patterns, customer-experience themes, and process breakdowns and communicate actionable findings to Quality, Operations, and Training leadership.

- Recommend refresher training, job aids, workflow clarification, scripting updates, or process improvements when recurring quality gaps are identified.

- Support new-hire nesting, targeted monitoring, remediation efforts, and other quality initiatives while maintaining objective evaluation standards.

Reporting, Documentation & Compliance

- Complete assigned quality reviews within established productivity, timeliness, and accuracy expectations and maintain complete audit records.

- Track and report quality results, critical-error trends, documentation accuracy, compliance findings, and other assigned quality measures using approved tools.

- Maintain confidentiality of patient information, employee performance information, recorded interactions, and audit findings and follow all applicable HIPAA, privacy, information security, and client requirements.

- Support internal, client, and program quality reviews by organizing audit evidence, validating findings, and providing supporting documentation.

- Follow Omega and client quality policies, scorecards, escalation paths, and security requirements and raise unclear or conflicting standards for review.

Key Success Indicators/Attributes

- Complete assigned quality reviews accurately and within established service levels, productivity expectations, and audit schedules.

- Maintain strong calibration alignment and apply quality standards objectively and consistently across representatives and interaction types.

- Identify critical errors and compliance risks promptly and escalate them with complete supporting documentation.

- Produce clear, actionable, fact-based feedback that supports coaching, training, process improvement, and a high-quality patient experience.

- Demonstrate strong analytical ability, attention to detail, written communication, and sound judgment when reviewing healthcare, insurance, and pharmacy-support interactions.

- Adapt effectively to changes in client requirements, quality standards, workflows, systems, products, and operating procedures.

- Maintains confidentiality, professionalism, reliability, and constructive working relationships with Operations, Training, Quality, and other internal partners.

Supervisory Responsibility

None required. This role provides quality feedback and audit findings but does not independently administer discipline or performance-management actions.

Work Environment

This role operates in a professional contact center environment, which may be onsite, hybrid, or remote depending on the assigned program and client requirements. The position routinely uses a computer, telephone/headset, dual monitors, quality-monitoring tools, CRM/case management systems, reporting applications, and multiple client systems and requires sustained attention to recorded interactions, documentation, and data analysis.

Physical Demands

The physical demands are representative of those required to perform the essential functions of this role.

The position primarily involves sitting, listening, speaking, typing, and viewing computer screens for extended periods, with occasional standing and walking.

Position Type/Expected Hours of Work

This is a full-time, non-exempt position. Work hours, time zone coverage, weekend or holiday requirements, and onsite, hybrid, or remote expectations are based on the assigned program and client requirements. Flexibility may be required for calibration sessions, training waves, or other quality needs.

Travel

Regular travel is not expected. Any travel requirement will be based on business or program needs.

Required Education and Experience

- High School Diploma or GED required.

- Two or more years of experience in a healthcare, pharmacy billing, patient-support , insurance, or similar contact center environment, with demonstrated knowledge of call handling, documentation, quality expectations, or regulated workflows.

- Working knowledge of U.S. healthcare insurance and pharmacy-support concepts, including copays, deductibles, coinsurance, out-of-pocket maximums, benefit verification, pharmacy claim responses, coordination of benefits, and common rejection scenarios.

- Strong analytical, written, and verbal communication skills, with the ability to evaluate interactions objectively, document findings clearly, interpret procedures, and distinguish coaching opportunities from critical or compliance errors.

- Proficiency with contact center technology, CRM/case management systems, quality-monitoring tools, Microsoft Office applications, and multiple data sources.

Preferred Education and Experience

- One or more years of quality assurance, quality monitoring, auditing, coaching, training, or advanced-agent experience in a healthcare, pharmacy, patient-support , or regulated contact center environment.

- Certified Pharmacy Technician ( CPhT ) certification is preferred. CPhT stands for Certified Pharmacy Technician; certification through the Pharmacy Technician Certification Board (PTCB) or another nationally recognized certifying organization is preferred. Active state pharmacy technician registration or licensure is also preferred where applicable.

- Spanish-speaking/English bilingual proficiency is preferred, particularly for quality monitoring of Spanish-language patient interactions and assessing accuracy, professionalism, and clarity in both languages.

- Additional post-secondary education, healthcare-related training, quality assurance training, or contact center quality certification is preferred.

Additional Eligibility Qualifications

- Ability and willingness to complete all required Omega, client, and program training, including quality calibration, emotional sensitivity, privacy, security, systems, and program-specific training.

- Ability to communicate constructively with representatives, supervisors, managers, trainers, Quality team members, and healthcare-related stakeholders while maintaining objectivity and confidentiality.

Security Access Requirements

Access to protected health information, recorded patient interactions, employee quality records, client systems, CRM/case management tools, quality-monitoring platforms, telephony applications, payer or pharmacy benefit systems, and other assigned applications may be required. All access is subject to Omega and client privacy, HIPAA, information security, and acceptable-use requirements.

Equal Employment Opportunity:

Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, genetic information, or any other basis protected by applicable law.

Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the hiring process, please contact Human Resources at [email protected].

Other Duties

This job description is not designed to cover every activity, duty, or responsibility required of the employee. Duties and responsibilities may change at any time with or without notice, and the employee may perform other duties as assigned.