Quality Analyst - Inpatient Coding

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.

RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS:

Registered Nurse with CIC/CCS certification and prior auditing / DRG experience preferred

Minimum one year experience working as Team Leader 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

Must be willing to work onsite

Office Locations:

15th Floor, Robinsons Cyberscape Gamma, Topaz Rd, Ortigas Center, Pasig, 1600

16th floor, 1 Nito Tower Archbishop Reyes Avenue Cebu City, 6000