quality analyst

7 days ago

Ayala Alabang, National Capital Region, Philippines Gear Inc. Full time ₱900,000 - ₱1,200,000 per year

Job description

This Quality Analyst (QA) role in Healthcare Accounts Receivable (AR) and Medical Billing is crucial for maintaining service excellence and revenue recovery by systematically ensuring compliance and accuracy in billing operations. Essentially, the QA acts as an internal auditor and performance driver within the team.

Here's a breakdown of the core functions and impact of the position:

Core Purpose

The primary purpose is to ensure claims are handled accurately and efficiently, which directly supports timely revenue recovery for clients. This is achieved by serving as a key checkpoint in the quality lifecycle to ensure strict compliance with:

  • Billing standards.
  • Payer guidelines.
  • Internal processes.

Key Responsibilities and Activities

The role balances auditing, performance analysis, and collaborative improvement.

1. Quality Assurance & Auditing

This is the operational core of the role, focused on identifying errors and maintaining consistency.

  • Daily Auditing: Review a sample of billers' work (case transcripts) and document findings in a standardized tracker.
  • Feedback & Alignment: Provide clear, structured feedback to specialists based on audit results. Engage in calibration sessions with operational and client leads to ensure scoring is consistent and fair.
  • Issue Resolution: Handle audit appeals and validate the logic behind the audit findings, making updates to feedback as necessary.
2. Performance Improvement & Collaboration

The QA is a direct partner in driving up team performance and resolving systemic issues.

  • Pattern Identification: Analyze audit results to identify patterns and recurring errors, escalating major compliance risks to leadership.
  • Targeted Training: Collaborate with Team Leads (TLs) and Trainers to conduct root cause analysis and plan targeted coaching or refresher training sessions to address these recurring issues.
  • Process Refinement: Partner with Operations to conduct joint root cause analysis and refine inefficient or non-compliant processes.
3. Reporting & Strategic Insights

The role provides the data-driven view of team performance for leadership and clients.

  • Data Analysis: Generate and analyze QA reports (daily, weekly, ad hoc) to highlight quality trends and process bottlenecks.
  • Risk Flagging: Identify outliers, productivity-to-quality gaps, and compliance risks.
  • Reporting: Prepare summaries and decks for both internal reviews and client-facing presentations.

Essential Skills and Background

To succeed, a candidate needs a strong combination of domain expertise, analytical prowess, and communication skills.

  • Domain Expertise: Minimum 1 year experience in healthcare AR, revenue cycle, or medical billing, coupled with in-depth knowledge of:

  • Billing practices and payer guidelines.

  • Denial management.
  • Compliance standards (e.g., HIPAA).
  • Leadership & Communication: Strong verbal and written communication skills (C1 English or above), with at least 1 year in a leadership role (for external candidates) to effectively deliver feedback and drive collaboration.
  • Analytical & Technical Skills: Must be detail-oriented with strong analytical, decision-making, and problem-solving skills, and proficient with MS Office/Google Drive, billing systems, and claim portals.

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