Quality Analyst, US Healthcare

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

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.

• 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.
• Worker's Compensation knowledge is needed.
• 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.