Quality Auditor Professional

6 days ago

Pasig, National Capital Region, Philippines Med-Metrix, LLC Full time

About Med-Metrix, LLC

We strive to be a leader in the quality services industry, driven by our commitment to excellence and our passion for delivering exceptional results. Our team is dedicated to providing top-notch quality assurance services that exceed expectations.

Job Overview

The Quality Analyst - Bilingual plays a critical role in supporting quality auditing, analysis, and reporting to ensure compliance with regulatory requirements. This role involves conducting thorough audits, analyzing data, and collaborating with cross-functional teams to implement process improvements.

Main Responsibilities

  • Develop and implement strategies to improve quality and reduce errors.
  • Analyze data to identify trends and patterns that impact quality and develop recommendations for change.
  • Collaborate with cross-functional teams to ensure effective communication and seamless implementation of changes.
  • Provide guidance and support to team members to enhance their knowledge and skills.
  • Maintain accurate records and reports to track progress and identify areas for further improvement.
  • Disseminate information and updates to relevant stakeholders to ensure successful implementation of changes.
  • Foster a culture of continuous learning and improvement within the organization.

Requirements

  • Bilingual in English and Spanish.
  • At least 2 years previous work experience as a Quality Analyst in healthcare insurance collections, self-pay collections, and customer service in a call center setting or compliance and/or training.
  • Experience with training new users.
  • Knowledge of EOBs, CPT & ICD-9 & 10 codes, HCFAs, UB92s, HCPCS, DRGs, and authorizations/referrals.
  • Strong understanding of the basic healthcare revenue cycle operational processes such as the functions of insurance, patient billing & collections, Managed Care, Medicare, Medicaid, and Commercial Practices.
  • Experience with practice management systems. EPIC PB, Allscripts, and/or Cerner preferred.
  • Knowledge of the denied claims and appeals process.
  • Ability to navigate through multiple software and computer applications.
  • Detail-oriented and well-organized.
  • Capacity to maintain a high level of objectivity when completing staff reviews.
  • Self-motivated and resourceful with the ability to multitask and successfully operate in a fast-paced, team environment.
  • Ability to work well individually and in a team environment.
  • Strong analytical and organizational skills.
  • Strong interpersonal skills, ability to communicate well at all levels of the organization.
  • Strong problem-solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses.
  • High level of integrity and dependability with a strong sense of urgency and results-oriented.
  • Ability to meet assigned deadlines and work under minimal supervision and with all levels of staff and management.
  • Excellent written and verbal communication skills required.
  • Gracious and welcoming personality for customer service interaction.

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