Quality Analyst - Medical Bill Review - Remote | Wfh

Are you passionate about ensuring accuracy and efficiency in medical bill review? We're seeking a skilled Quality Analyst to join our team and help us maintain the highest standards of quality and compliance. As a Quality Analyst, you'll conduct pre- and post-payment audits to ensure compliance with state guidelines, rules, and regulations, and provide consistent reporting and communication regarding audit findings. You'll also work closely with our managers and teams to identify opportunities for improvement and recommend modifications to procedures and processes.
Responsibilities
Conduct claims audits to ensure claims processors accurately identify and escalate complex bills per documented guidelines, code provider bills in accordance with program guidelines, and pay providers in an accurate and timely manner.
Conduct pre- and post-payment audits within Bill Review to ensure compliance with state guidelines, rules, regulations, and performance guarantees.
Provide consistent reporting and communication with respect to audit findings in all areas of operations within Sedgwick Bill Review.
Lead Quality audits specific to Bill Review vendors, independent operational units, as well as client-specific.
Provide random quality audits of our Provider Customer Service Center to ensure accuracy and quality outcomes.
Provide input to SGS managers and teams regarding analysis, updates, and recommendations for modifications for procedures and processes to continually improve operations and protocols.
Assist with the collection and summary of data in collaboration with SGS Quality Committees, identify opportunities for improvement, and present findings.
Understand each contract's clinical quality assurance requirements and monitor compliance, in collaboration with the SGS analytics and management teams.
Perform standard and ad hoc audits of claims activities, as directed by quality committees.
Qualifications
Bachelor's degree or equivalent experience and education required.
At least five (5) years of medical bill review or claims processing experience or an equivalent combination of education and experience is required. Knowledge of medical terminology is preferred.
At least three (3) years of experience with Quality Management including project management, quality improvement, corrective action, auditing, and/or staff education.
Federal Employees Compensation Act (FECA) Experience, Preferred.
Medicare/Medicaid rules and regulations experience, preferred.
Excellent oral and written communication skills.
PC literate, including Microsoft Office products.
Detail-oriented, strong analytical and organizational skills.
Strong organizational skills.
Good interpersonal skills.
Ability to work in a team environment.
Ability to meet or exceed Performance Competencies.
U.S. Citizenship.
Prior to hiring and training, must be able to pass a preliminary credit and background check.
If you're a detail-oriented individual with strong analytical and organizational skills, and you're looking for an opportunity to make a difference in the medical billing industry, we encourage you to apply today.
Employment Type: Full-Time
Salary: $ 26.00 Per Hour