Healthcare Quality Assurance Specialist

6 days ago

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

About Med-Metrix, LLC

At Med-Metrix, LLC, we are dedicated to delivering exceptional quality services that drive positive outcomes. Our team of professionals is committed to excellence in all aspects of our work.

Job Summary

The Quality Analyst - Bilingual supports quality auditing, analysis, and reporting to ensure compliance with regulatory requirements. This role involves identifying areas for improvement, developing strategies to address these issues, and implementing changes to enhance the quality of our services.

Key Responsibilities

  • Conduct thorough audits to identify areas for improvement and develop recommendations for change.
  • Analyze data to understand trends and patterns that impact quality.
  • Collaborate with cross-functional teams to implement process improvements and ensure effective communication.
  • Participate in performance improvement activities and continuing education to maintain current credentials and enhance 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 seamless 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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