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Quality Analyst - Medical Bill Review (Remote) 2023-1270
Company | Managed Care Advisors (MCA) |
Address | Bethesda, MD, United States |
Employment type | FULL_TIME |
Salary | |
Category | Wellness and Fitness Services |
Expires | 2023-05-16 |
Posted at | 1 year ago |
Orlando, FL, USA
- Understand each contract's clinical quality assurance requirements and monitors compliance, in collaboration with the SGS analytics and management teams.
- Perform standard and ad hoc audits of claims activities, as directed by quality committees.
- Pay providers in an accurate and timely manner
- Assist with performance improvement activities.
- Code provider bills in accordance with program guidelines
- Provide input to SGS managers and teams regarding analysis, updates, and recommendations for modifications for procedures and processes to continually improve operations and protocols.
- Track client complaints and issues to resolution, in collaboration with the Account Managers.
- Identify and escalate complex bills per documented guidelines.
- Assist with the collection and summary of data in collaboration with SGS Quality Committees, identify opportunities for improvement, and present findings.
- Conduct claims audits to ensure claims processors:
- Identify new areas that need quality monitoring, on a short-term or continuous basis.
- Strong organizational skills
- Medicare/Medicaid rules and regulations experience, preferred.
- Excellent oral and written communication
- One (1) year of bill review or claims processing experience or an equivalent combination of education and experience is required. Knowledge of medical terminology is preferred.
- PC literate, including Microsoft Office products
- Federal Employees Compensation Act (FECA) experience, preferred.
- Good interpersonal skills
- Ability to meet or exceed Performance Competencies
- High School diploma or GED required.
- US Citizen
- Ability to work in a team environment
- One (1) year of quality management or auditing experience, is preferred.
- Detail-oriented, strong analytical and organizational skills
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