Corp Managed Svcs RCMS

Computer Science, Data Analytics, Accounting

Preferred Field(s) of Study: 

Minimum Year(s) of Experience (BQ) *: US

2years of experience

Certification(s) Preferred: 

Required Knowledge/Skills (BQ):

Preferred Knowledge/Skills *: 

The quality control analyst conducts quality control audits of patient accounts referred to the Revenue Cycle Managed Services (RCMS) and assures company and client standards are maintained and the integrity of client services are preserved. The Quality Control Analyst will perform a variety of functions including, but not limited to: reviewing and monitoring accounts, identifying problems, analyzing trends and suggesting recommendations for improvements. This role consults with and takes direction from the Continuous Improvement Specialist to resolve quality and efficiency issues that may occur on any given project. 

• Years of Experience: 2-4 years is required in the following areas:Medical collections (Medical Collections Specialist II preferred), billing and/or claims experience

• Customer service experience 

• ll payer knowledge required (government and non-government)
  
  Responsibilities: 
  
  As Quality Control Analyst specific responsibilities include but are not limited to:

• Performs quality control audits; reviews and monitors accounts.

• Identifies problems, analyzes cause and effect, and suggests recommendations for improvement;

• Provides daily constructive feedback based on account notation;

• Identifies areas of weakness and communicates recommendations on changes and improvement to Continuous Improvement Specialists;

• Document findings of analysis. May prepare reports and suggests recommendations of implementation of new systems, procedures or organizational changes;

• Relies on specific instructions and pre-established guidelines to perform the functions of the job;

• Possesses ability to be confidential; Supports company compliance by demonstrating adherence to all relevant compliance policies and procedures; demonstrates knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of sensitive information;

• Consults and collaborates with Continuous Improvement Specialist to identify and assess training needs based on work audited;

• Participate in quality control meetings;

• Possesses considerable leadership skills, fostering an atmosphere of trust; seeks diverse views to encourage improvement and innovation; coaches and develops staff through timely and meaningful written feedback;

• Possesses a cooperative and positive attitude toward management and co-workers by responding politely and professionally and being a valued team player; and,

• Exemplifies extensive knowledge of the hospital revenue cycle with specialization in healthcare billing, follow-up, and the account resolution process to include, but not limited to: claims submission, acceptance, and adjudication, transaction reviews, adjustment posting, identification of patient responsibility, etc.
  
  
  Required Knowledge and Skills:
  
  

• Good analytical and math skills.

• Able to document problems and assist in their resolution.

• Demonstrated ability exceeding all established department/client quality and productivity standards;

• Proven ability to lead by example and foster mentoring relationships.

• Strong written and oral communication skills.

• Computer and internet literate in an MS Office environment; and,

• Ability to establish and maintain effective working relationships.

• US Healthcare Commercial and Managed Care Insurance Claim Management/Billing/Claim Edit Resolution 

• US Healthcare Medicare and Medicaid Insurance Claim Management/Billing/Claim Edit Resolution 

• US Healthcare Denials Management (technical and clinical) 

• US Healthcare Underpayment/Payment Variance Management 

• Experience Level: 2 to 4 years.

• Shift timings: Flexible to work in night shifts (US Time zone)

• Preferred Qualification: Bachelor’s degree in finance or Any Graduate