Quality Analyst, US Healthcare

Experience these exceptional benefits when you join Med-Metrix

• 8-Hour Shifts, Fixed Weekends Off
• Day 1 HMO with 2 of your dependents covered for FREE
• Medical Cash Allowance
• Rice Allowance
• Clothing Allowance
• Free Lunch Daily
• Paid Time Off
• Training and Staff Development
• Employee Engagement Activities
• Opportunities for Internal Mobility

The Quality Analyst, US Healthcare supports quality auditing, analysis, reporting and the development of plans that lead to positive outcomes. The position also requires engagement in working on risk identification, diagnosing issues, identifying process improvement solutions and process improvement implementation methods utilizing sound principles. Continuous engagement and collaboration with the Operations and Training Team is essential.

Duties and Responsibilities:

• Ensure that project related quality processes are followed by denials analyst and client specific and internal metrics are achieved.
• Prepare detailed reports on audit findings and understand the quality requirements both from process perspective and for targets. Deliver quality reports in a timely manner.
• Identify a method to achieve the quality targets and implement the same in consultation with QCA lead and/or managers. Assist with the Quality Assessment process to ensure all quality standards targets can be met.
• Participate in performance improvement activities and continuing education to maintain current credentials, and enhance knowledge and skills.
• Share all relevant information with the team and take initiative to ensure team members get projects completed. Participate in client presentation of findings, when requested.
• Adjust workloads as necessary to achieve successful completion of project.
• Handle complaints, questions, and queries as necessary.
• Disseminates changes in guidelines and rules; monitor changes in laws, regulations, and policies that impact clinical documentation, reimbursement to assure compliance.
• Foster an environment of teamwork and service excellence within the department.
• Participate in conference calls/meetings with management and staff to ensure all performance and training recommendations are addressed and improvement suggestions are implemented.
• Assist in new hire training classes, transition periods and refresher trainings as needed.
• Knowledge of, understanding of, and compliance with all Med-Metrix policies and procedures.
• Participates in presentations to educate staff on outcomes and plans of correction.
• Ability to meet assigned deadlines and work under minimal supervision and with all levels of staff and management.
• Maintain required productivity standards.
• Perform other duties as necessary.

Qualifications

• 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.
• Must have 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.
• Experience with Physician/Professional Billing.
• Knowledge of the denied claims and appeals process.
• Must have an experience in outbound transaction AR process (Payers)
• Ability to navigate through multiple software and computer applications.
• Detail oriented and well organized
• Ability to perform under pressure in a calm manner & maintain a positive attitude.
• Excellent customer service, verbal, written, listening and interpersonal skills.
• Knowledge of EOBs, CPT & ICD-9 & 10 codes, HCFAs, UB92s, HCPCS, DRGs and authorizations/ referrals.
• Capacity to maintain a high level of objectivity when completing staff reviews.
• Proficient computer skills including Microsoft Office Suite. Must have intermediate Excel skillset.
• Self-motivated and resourceful with the ability to multitask and successfully operate in a fast paced, team environment.
• Experience with training new users.
• Ability to work well individually and in a team environment.
• Must adapt well to change and successfully set and adjust priorities as needed.
• Strong communication skills/oral and written.
• Strong analytical skills
• Strong organizational skills
• Must be willing to work during US hours.
• Must be willing to work onsite.