PHRN Quality Control Analyst (RCM or Hospital Billing) | PASIG

Omega Healthcare Management Services Inc.; Pasig; On-site; PHP 420,000 - 660,000; Full time

Job summary

Omega Healthcare Management Services Inc. is seeking a detail-oriented Quality Analyst to ensure compliance and drive performance across healthcare accounts. You will conduct audits, monitor interactions, and provide actionable feedback to teams, leveraging analytics to identify gaps and opportunities.

The ideal candidate has 2+ years in QA within healthcare or BPO, knowledge of InterQual/MCG criteria, and strong Excel/PowerPoint skills to present insights to stakeholders.

Qualifications

• Active PHRN license preferred but not required, depending on account requirements.
• At least 2 years of Quality Analyst/Quality Control Analyst experience in a healthcare account.
• Experience in a BPO or healthcare operations environment.
• Strong background in quality auditing, monitoring, compliance, and performance evaluation.
• Experience providing audit feedback, conducting calibrations, and identifying process improvement opportunities.
• Knowledge of Prior Authorization, Utilization Management, Claims, Appeals, or RCM is an advantage.
• Strong analytical, communication, and reporting skills.

Responsibilities

• Conduct quality audits and evaluations based on established guidelines and quality standards.
• Monitor and assess customer interactions, transactions, or cases to ensure compliance with client and company requirements.
• Provide timely and constructive feedback to employees and stakeholders regarding audit results.
• Identify quality trends, performance gaps, and areas for improvement.
• Participate in calibration sessions to ensure scoring accuracy and consistency.
• Prepare audit reports, quality summaries, and performance analyses.
• Collaborate with Operations, Training, and other support teams to address quality concerns and improve performance.
• Ensure adherence to compliance, regulatory, and client-specific requirements.
• Assist in developing and recommending process improvement initiatives based on audit findings.
• Maintain accurate documentation of audits, feedback sessions, and quality-related activities.
• Utilize Excel and other reporting tools to track and present quality metrics.
• Support continuous improvement efforts to enhance customer experience and operational performance.

Skills

Quality auditing

Regulatory compliance

Performance evaluation

Audit feedback

Calibrations

Process improvement

Data analysis

Stakeholder management

Communication skills

Tools

MS Excel

PowerPoint

Job description

About Omega Healthcare

Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) is an AI-driven healthcare solutions company that partnersacross the healthcare ecosystem to deliver breakthrough resultsby reimagining and elevating revenue operations.Powered by the Omega Digital Platform®, our agentic AI engineleverages adaptive intelligence to drive automation, complemented by deep human expertise to help optimize performance and deliver sustained financial and clinical outcomes—while enhancing patient satisfaction.

Omega Healthcare empowers organizations across provider, payer, and life sciences sectorsto navigate today’s healthcare challenges while building the agility to adapt as healthcare and technology continue to evolve rapidly.Recognized by industry analysts, Omega Healthcare has consistently been ranked a leader in driving operational performance excellence.

Key Responsibilities

• Conduct quality audits and evaluations based on established guidelines and quality standards.

• Monitor and assess customer interactions, transactions, or cases to ensure compliance with client and company requirements.

• Provide timely and constructive feedback to employees and stakeholders regarding audit results.

• Identify quality trends, performance gaps, and areas for improvement.

• Participate in calibration sessions to ensure scoring accuracy and consistency.

• Prepare audit reports, quality summaries, and performance analyses.

• Collaborate with Operations, Training, and other support teams to address quality concerns and improve performance.

• Ensure adherence to compliance, regulatory, and client-specific requirements.

• Assist in developing and recommending process improvement initiatives based on audit findings.

• Maintain accurate documentation of audits, feedback sessions, and quality-related activities.

• Utilize Excel and other reporting tools to track and present quality metrics.

• Support continuous improvement efforts to enhance customer experience and operational performance.

Qualifications

• Active PHRN license preferred but not required, depending on account requirements.

• At least 2 years of Quality Analyst/Quality Control Analyst experience in a healthcare account.

• Experience in a BPO or healthcare operations environment.

• Strong background in quality auditing, monitoring, compliance, and performance evaluation.

• Experience providing audit feedback, conducting calibrations, and identifying process improvement opportunities.

• Knowledge of Prior Authorization, Utilization Management, Claims, Appeals, or RCM is an advantage.

• Strong analytical, communication, and reporting skills.

Clinical Requirements

• At least 1 year experience in Utilization Review and/or Clinical Appeals

• Strong knowledge of InterQual and/or MCG criteria (required)

• Experience in outpatient services and/or hospital admissions review preferred

Technical Skills

• Proficient in MS Excel (Pivot Tables, VLOOKUP, dashboards)

• Skilled in PowerPoint presentations

Core Skills

• Strong leadership, coaching, and mentoring skills

• Excellent communication and stakeholder management

• Analytical and data-driven decision-making

• Ability to thrive in a fast-paced, evolving environment