Quality Analyst
2 weeks ago
Summary:
The Quality Analyst is responsible for training and quality analysis, working closely with both onshore and offshore managers to ensure high training and quality standards for assigned portfolios/teams. This role involves identifying process gaps, conducting training, and ensuring compliance with quality expectations.
Key Responsibilities:
- Develop expertise in claims management across assigned portfolios.
- Analyze training and quality needs to identify and address process and educational gaps.
- Conduct new hire and refresher training, including assessments.
- Create an engaging learning environment suited to various learning styles.
- Serve as a subject matter expert, supporting team members in meeting quality expectations.
- Meet individual productivity and audit goals on a weekly basis.
- Assist offshore and training managers in implementing training and quality-related processes.
- Develop and maintain training materials, including presentations and process guides.
- Conduct quality calibrations to align team members with quality and process standards.
- Collaborate with portfolio managers to address quality gaps and improvement opportunities.
- Perform quality audits, analyze data, and strategize with managers to improve quality outcomes.
Skills and Qualifications:
- Previous experience in a training and quality role, preferably in a healthcare or claims management setting.
- Extensive knowledge of Commercial and Government Insurance plans, eligibility, and medical billing.
- Strong understanding of HIPAA, PHI guidelines, CPT, ICD-10, UB, HCFA, and 837 terminologies.
- Excellent interpersonal and customer service skills.
- Strong attention to detail, problem-solving, and analytical skills.
- Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint).
- Familiarity with Google Suite (Google Drive, Sheets, etc.).
- Excellent verbal and written communication skills.
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