Healthcare Quality Analyst - Audits & Improvement

Med-Metrix; Manila; On-site; PHP 600,000 - 900,000; Full time

Job summary

Med-Metrix is seeking a Quality Analyst to support quality auditing, analysis, reporting and the development of improvement plans in a healthcare setting. The role emphasizes HIPAA compliance, risk analysis, and collaboration with Operations and Training teams.

The candidate should have at least 2 years of QA experience in healthcare insurance collections or customer service, with strong communication and problem-solving skills to drive performance improvements and ensure adherence to policies.

Qualifications

• 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, HCFAs, UB92s, HCPCS, DRGs and authorizations/referrals
• Strong understanding of the basic healthcare revenue cycle operational processes such as the functions of insurance, patient billing & collections, Managed Care, Medicare, Medicaid, and Commercial Practices
• Knowledge of the denied claims and appeals process
• Must have an experience in outbound transaction AR process (Payers)
• Proficient computer skills including Microsoft Office Suite, intermediate Excel skills required
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses

Responsibilities

• Ensure project related quality processes are followed by denials analyst and client specific and internal metrics are achieved
• Prepare detailed reports on audit findings and understand the quality requirements both from process perspective and for targets. Deliver reports in a timely manner.
• Identify a method to achieve the quality targets and implement the same in consultation with QCA lead and/or managers.
• Assist with the Quality Assessment process to ensure all quality standards targets can be met.
• Participate in performance improvement activities and continuing education to maintain current credentials and enhance knowledge and skills
• Share all relevant information with the team and take initiative to ensure team members get projects completed
• Participate in client presentation of findings, when requested
• Adjust workloads as necessary to achieve successful completion of project
• Handle complaints, questions, and queries as necessary
• Disseminates changes in guidelines and rules; monitor changes in laws, regulations, and policies that impact clinical documentation, reimbursement to assure compliance
• Foster an environment of teamwork and service excellence within the department
• Participate in conference calls/meetings with management and staff to ensure all performance and training recommendations are addressed and improvement suggestions are implemented
• Assist in new hire training classes, transition periods and refresher trainings as needed
• Maintain knowledge, understanding of, and compliance with all Med-Metrix policies and procedures.
• Participate in presentations to educate staff on outcomes and plans of correction
• Other duties as assigned
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Tools

EPIC PB

Allscripts

Cerner

Job description

Med-Metrix is seeking a Quality Analyst to support quality auditing, analysis, reporting and the development of improvement plans in a healthcare setting. The role emphasizes HIPAA compliance, risk analysis, and collaboration with Operations and Training teams.

The candidate should have at least 2 years of QA experience in healthcare insurance collections or customer service, with strong communication and problem-solving skills to drive performance improvements and ensure adherence to policies.