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2+ years
Not Disclosed
10 Nov. 13, 2024
Job Description
Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Job Description: Quality Auditor in RCM - US Healthcare

Experience: Minimum of 2 years in the RCM domain, preferably in a Quality Auditor or Expert role within Accounts Receivables.

Key Responsibilities:

  • RCM Expertise: Strong knowledge of medical billing and end-to-end Revenue Cycle Management (RCM) processes, including the identification, analysis, and resolution of denials and remark codes.
  • Claims Management: Ability to take prompt action on denials and manage claim follow-ups to facilitate payment collection.
  • Error Monitoring & Analysis: Analyze and monitor RCM process errors; audit both immediate and long-term error corrections.
  • Quality Metrics: Quantify error rates by individual, team, client, and client pools to identify trends and optimize quality.
  • Training & Development: Create training materials and tests from error analysis; conduct refresher training sessions to address common issues.
  • Automation & Solutions: Develop automation solutions to reduce error rates and improve process efficiency.
  • Billing Issue Resolution: Address and resolve billing issues that lead to payment delays.
  • Quality Assurance: Oversee call and data quality monitoring, providing constructive feedback to agents and coaching on process-level issues.
  • Compliance Monitoring: Ensure adherence to compliance procedures, reporting quality scores to process owners.
  • Client & Team Communication: Lead calibration and performance review calls with clients and internal teams to discuss quality.
  • Performance Analysis: Conduct weekly SLA analysis, brainstorming sessions, and root cause analysis to enhance operational performance.
  • Risk Management: Identify potential risk areas, recommend preventive actions, and maintain a robust monitoring system to uphold key quality metrics.

Outcome: Ensure consistent, high-quality RCM performance across the team while continuously improving processes and maintaining compliance.