PHRN - CPC - Quality Analyst

Job Title : Quality Analyst

Quality Analyst is responsible to perform activities outlined in the Service Quality Plan and identify auditor / program level improvement opportunities. QA Analyst is required to work closely with the production resources to ensure adherence to the client and process specific requirements. Ensure that regular feedback and error sharing sessions are conducted to avoid repetition of errors and help improve overall performance. Other activities of the quality analyst include – reporting, calibrations, process analysis and attending client and internal meetings.

Responsibilities:

• Responsible for quality monitoring on claims/cases/transactions and/or telephonic interactions • Conduct Process training as and when required • Provide feedback to auditors/clinical team members using prescribed feedback model • Mentoring and coaching auditors on process level issues. • Monitor adherence to compliance procedures and processes. • Responsible for reporting program level quality score to the process owners. • Responsible for conducting calibration and performance review call in terms of quality with the internal team. (Initially will be assisting the senior quality analyst, training and guidance will be provided to be able to lead such meetings in future). • Conduct refresher training on the basis of the errors identified. • Communicate process updates by conducting a session as and when required. • Maintaining update log and sharing it with the team on a regular basis. • Perform brainstorming and root cause analysis to analyse data and provide tips or suggestions to operations/management team. • Identify and highlight potential risk areas and recommend preventive action..

ATTRIBUTES AND BEHAVIORS

• Develops and maintains positive working relationships with others. • Shares ideas and information. • Assists colleagues unprompted. • Takes pride in the achievement of team objectives. • Has credibility with peers and senior managers. • Self-motivated – driven to ac • Self-motivated – driven to achieve results. • Works with a sense of urgency. • High customer service ethic – is passionate about meeting customer expectations and improving service levels. • Keeps pace with change – acquires knowledge/skills as the business evolves. • Handles confidential information with sensitivity. • Exhibits behaviours consistent with Cotiviti Values

RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS

• Registered Nurse (PHRN/USRN) with CPC certification and prior auditing • Minimum one year experience working as QA or equivalent • Experience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferred • Possesses knowledge of healthcare claims payment policy and processing – • specifically, CMS, Medicaid regulations, AAOS, ICD-9, CPT & HCPCS, etc. • Practical clinical experience working in a hospital/office or nursing home • Has general knowledge of medical procedures, conditions, illnesses, and treatment practices • Possesses excellent written and verbal communication skills. Ability to think logically • and process sequentially with a high level of detailed accuracy and efficiency • Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc. • Experience working as a Quality Analyst will be an added advantage • College degree mandatory.

SKILLS & COMPETENCIES

• Excellent communication skills (written and verbal) • Excel proficiency. • Ability to work well under pressure and meet deadline. • Ability to work on multiple projects simultaneously.

JOB DEMANDS

• Training/OJT will be during US daytime • Ability to work seated at a computer for long periods of time • Candidate should be ready to work in different shifts, including night shift

KEY CONSTITUENTS

Internal – • Quality Manager and Team Leader • Operations Manager and Team Leader • Production Resources External – Clients and Onshore Business Partners