Healthcare Quality Analyst — Audits, Compliance & Improvement

Med-Metrix; Pasig; Presencial; PHP 446 000 - 670 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Fixed weekends off

HMO coverage (Day 1 with dependents)

Medical allowance

Rice allowance

Clothing allowance

Free lunch daily

Paid time off

Staff training & development

Employee engagement activities

Internal mobility opportunities

Resumo da oferta

Med-Metrix is seeking a Quality Analyst to support quality auditing, reporting, and improvement initiatives in the healthcare insurance and patient services domain. The role emphasizes risk identification, data-driven analysis, and collaboration with Operations and Training teams.

Responsibilities include reports, process improvement, training, and ensuring adherence to HIPAA and company policies while delivering high-quality outcomes for clients in a fast-paced environment.

Qualificações

• At least 2 years previous work experience as a Quality Analyst in healthcare insurance collections, self-pay collections and customer service in a call center setting or compliance and/or training.
• Experience with training new users.
• Knowledge of EOBs, CPT & ICD-9 & 10 codes, HCFA forms, UB92s, HCPCS, DRGs and authorizations/referrals.
• Strong understanding of healthcare revenue cycle processes including insurance, patient billing & collections, Managed Care, Medicare, Medicaid, and Commercial practices.

Responsabilidades

• Ensure project related quality processes are followed by denials analyst and client specific/internal metrics are achieved.
• Prepare detailed reports on audit findings and understand quality requirements from process perspective.
• Identify methods to achieve quality targets and implement with QCA lead/managers.
• Participate in performance improvement activities and continuing education to maintain credentials.
• Share information with the team and ensure project completion.
• Participate in client presentations of findings when requested.
• Adjust workloads to achieve successful project completion.
• Handle complaints, questions, and queries as necessary.
• Disseminate changes in guidelines and monitor HIPAA/compliance updates.
• Foster teamwork and service excellence within the department.
• Assist in new hire training and refresher trainings as needed.
• Maintain knowledge of Med-Metrix policies and procedures.
• Present outcomes and correction plans to educate staff.

Conhecimentos

Quality analysis

Data analysis

Reporting

HIPAA compliance

Quality improvement

Interpersonal skills

Microsoft Excel

Customer service

Training new users

Communication

Ferramentas

EPIC PB

Allscripts

Cerner

Microsoft Office Suite

Descrição da oferta de emprego

Med-Metrix is seeking a Quality Analyst to support quality auditing, reporting, and improvement initiatives in the healthcare insurance and patient services domain. The role emphasizes risk identification, data-driven analysis, and collaboration with Operations and Training teams.

Responsibilities include reports, process improvement, training, and ensuring adherence to HIPAA and company policies while delivering high-quality outcomes for clients in a fast-paced environment.