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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 for RCM Quality Auditor

Position: RCM Quality Auditor
Experience: Minimum 2 years in the U.S. healthcare Revenue Cycle Management (RCM) domain, preferably as a Quality Auditor or Expert in Accounts Receivables.

Key Responsibilities:

  • Manage and monitor end-to-end medical billing processes, with expertise in handling denials and remark codes for swift resolution and payment collection follow-up.
  • Analyze and audit RCM errors, conducting short- and long-term error correction audits.
  • Quantify error rates and trends at individual, team, and client levels to improve quality.
  • Develop training materials and assessments based on error analysis and create automation solutions to reduce error rates.
  • Troubleshoot billing issues that cause payment delays.
  • Oversee call and data quality, providing feedback to agents and coaching on process-level issues.
  • Monitor compliance with established RCM procedures and report quality scores to process owners.
  • Conduct quality calibration sessions and performance reviews with both internal teams and clients.
  • Deliver refresher training based on error analysis findings.
  • Analyze weekly SLA performance, conduct root cause analysis, and offer improvement suggestions to management.
  • Identify risk areas in RCM processes and recommend preventive actions.
  • Maintain a monitoring system to ensure adherence to program metrics and quality standards.

Qualifications:

  • Strong knowledge of denials, remark codes, and payment collection protocols.
  • Experience in training and mentoring teams in RCM processes.
  • Proficiency in compliance monitoring and root cause analysis.