Welcome Back

Google icon Sign in with Google
OR
I agree to abide by Pharmadaily Terms of Service and its Privacy Policy

Create Account

Google icon Sign up with Google
OR
By signing up, you agree to our Terms of Service and Privacy Policy
Instagram
youtube
Facebook
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.