A Quality Analyst, working within the Advantum Process Improvement team, is responsible for monitoring compliance with billing rules/regulations by conducting reviews/audits of completed work files, educating professionals about workflow, process, documentation, and best practices; and recommending appropriate corrective actions surrounding revenue cycle services. Ensuring quality and integrity in the revenue cycle is key in this role.
- Life science Graduate or Post Graduate from a recognized educational institute.
- Must be certified (CPC/COC).
- Candidate must have minimum 5 years of experience in medical coding, and minimum 1 year of experience in medical coding audit.
- Good and expertise knowledge in multiple specialty of coding (E&M coding, Surgery and HCC.)
- Good Knowledge of medical terminology.
- Knowledge of Medicare and Medicaid billing rules required.
- Knowledge of clinical workflow.
- Process improvement mindset and ability to impact change is a must.
- Good analytical skills and proficiency with MS Word, Excel and PowerPoint.
- Excellent written & verbal communication skills.
- Performing daily audits of coding team and sending audit report on daily basis.
- Providing effective and constructive feedback to the associates and to help in improving their performance.
- Displaying cool and composed attitude during rebuttals and discussions.
- Meet daily with Team leaders/Supervisor and teammates to review previous day quality results
- Highlight potential issues in the operations to management.
- Weekly review with supervisors.
- Work closely with new hires, anyone new to a process, or having difficulty with errors to ensure quality work delivery in the future.
- Trending errors to determine training opportunities.
- May provide small group or one-on-one training/cross-training.
- Develop recommendations for corrective action based on quality issues.
- Maintains current knowledge of Advantum Health policies and guidelines related to documentation, coding, billing, revenue cycle, and as assigned, other professional integrity topics.
- Develops or assists in developing training materials. Participates in a positive, helpful, manner at Quality staff meetings and at other Advantum Health meetings as assigned.
- Taking initiatives to improve process and quality mechanism
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