Quality Analyst / Auditor (RCM - US Healthcare)

Elite HR Services; Tiruchirappalli, Bengaluru; Presencial; INR 450.000 - 650.000; Jornada completa

Descripción de la vacante

Elite HR Services seeks an Audit Analyst to perform comprehensive audits across departments, ensuring compliance with Medicare, Medicaid, and workers' compensation rules. You will identify training needs, drive process improvements, and support internal and external audits while liaising with staff and physicians.

The role requires strong analytical skills, proficiency with MSI patient accounting and Microsoft Office tools, and excellent communication to translate findings into actionable

Formación

• In-depth knowledge of Medicare, Medicaid, Workers Compensation guidelines and requirement.
• In-depth knowledge of the MSI patient accounting system and report writing.
• In-depth knowledge of chronic/acute pain billing.
• Detailed audit approach and methods for testing accuracy and compliance to defined billing guidelines.
• Analytical skills to summarize audit findings into statistically meaningful reports.
• Ability to work effectively and independently with staff, physicians, and external customers.
• Must have strong keyboard skills with knowledge of Microsoft Word, Excel and PowerPoint.
• Excellent verbal and written communication skills.

Responsabilidades

• Complete audit analysis and reports at the individual, department and division level based on defined position pathways and individual / department performance and quality metrics.
• Identify specific individual and department training needs and opportunities for performance improvement through a defined audit analysis program and assist in ongoing process improvement opportunities through audit analysis.
• Audit work in the Charge Entry, Payment Posting and Collections Departments to determine compliance with Policies and Procedures.
• Provide follow up review of policy changes and implementation of those changes into audit process and reporting.
• Maintain current knowledge of Medicare, Medicaid, Work Comp guidelines and rules.
• Assist with internal and external compliance audits, account reviews on an as-needed basis.
• Work with process improvement team to improve quality and performance through process improvement initiatives.

Conocimientos

Audit analysis

Performance metrics

Policy compliance

Analytical skills

Verbal & written communication

Herramientas

MS Word

MS Excel

MS PowerPoint

Descripción del empleo

Responsibilities

• Complete audit analysis and reports at the individual, department and division level based on defined position pathways and individual / department performance and quality metrics.
• Identify specific individual and department training needs and opportunities for performance improvement through a defined audit analysis program and assist in ongoing process improvement opportunities through audit analysis.
• Audit work in the Charge Entry, Payment Posting and Collections Departments to determine compliance with Policies and Procedures.
• Provide follow up review of policy changes and implementation of those changes into audit process and reporting.
• Maintain current knowledge of Medicare, Medicaid, Work Comp guidelines and rules.
• Assist with internal and external compliance audits, account reviews on an as-needed basis.
• Work with process improvement team to improve quality and performance through process improvement initiatives.

Requirements

• In-depth knowledge of Medicare, Medicaid, Workers Compensation guidelines and requirement
• In-depth knowledge of the MSI patient accounting system and report writing
• In-depth knowledge of chronic/acute pain billing
• Detailed audit approach and methods for testing accuracy and compliance to defined billing guidelines
• Analytical skills to summarize audit findings into statistically meaningful reports
• Ability to work effectively and independently with staff, physicians, and external customers
• Must have strong keyboard skills with knowledge of Microsoft Word, Excel and PowerPoint
• Must have a pleasant disposition and high tolerance level for diverse views
• Excellent verbal and written communication skills