Quality Analyst (Healthcare AR Follow Up) w/ 35K Sign On Bonus

Med-Metrix; Pasig; On-site; PHP 360,000 - 540,000; Full time

Benefits offered by this job

Day 1 HMO coverage for employee and 2-

Clothing Allowance

Free Lunch Daily

Paid Time Off

Training and Staff Development

Employee Engagement Activities

Internal Mobility Opportunities

Job summary

Med-Metrix in Metro Manila seeks a Quality Analyst to support auditing, analysis, reporting, and improvement plans for positive outcomes. The role collaborates with Operations and Training to address quality standards and HIPAA compliance.

Night shift, onsite in Pasig, with duties including detailed audit reporting, training support, and performance improvement initiatives to ensure top-tier service delivery.

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 revenue cycle processes in insurance, patient billing & collections.
• Experience with practice management systems (EPIC PB, Allscripts and/or Cerner preferred).
• Knowledge of denied claims and appeals process.
• Ability to navigate multiple software applications and multitask in a fast-paced environment.
• Strong interpersonal and communication skills; proactive and team-oriented.

Responsibilities

• Ensure project quality processes are followed and metrics are achieved.
• Prepare detailed audit reports and understand quality requirements from process and target perspectives.
• Identify methods to achieve quality targets and implement with QCA lead or managers.
• Participate in performance improvement activities and ongoing education.
• Share information with the team and ensure project completion.
• Participate in client presentations of findings when requested.
• Adjust workloads to meet project deadlines and handle inquiries.
• Maintain HIPAA compliance and protect PHI; monitor policy changes.

Skills

Quality Analyst

Healthcare knowledge

Training experience

HIPAA compliance

Analytical skills

Communication

Tools

EPIC PB

Allscripts

Cerner

Job description

Join our dynamic team and make a meaningful impact in the healthcare industry. Enjoy competitive benefits upon hire, ongoing professional development, and the satisfaction of helping others every day. Take the next step in your career with Med-Metrix!

Experience these exceptional benefits when you join Med-Metrix!

• Day 1 HMO with 2 of your dependents covered for FREE
• Clothing Allowance
• Free Lunch Daily
• Paid Time Off
• Training and Staff Development
• Employee Engagement Activities
• Opportunities for Internal Mobility

Job Purpose

The Quality Analyst supports quality auditing, analysis, reporting and the development of plans that lead to positive outcomes. The Quality Analyst will work on risk identification, diagnosing issues, identifying process improvement solutions and process improvement implementation methods utilizing sound principles. Continuous engagement and collaboration with the Operations and Training Team is essential.

Duties & Responsibilities

• Ensure that 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
• Perform other duties as necessary
• 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

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
• Experience with practice management systems. EPIC PB, Allscripts and/or Cerner preferred
• Knowledge of the denied claims and appeals process
• Must have an experience in outbound transaction AR process (Payers)
• Ability to navigate through multiple software and computer applications
• Detail oriented and well organized
• Capacity to maintain a high level of objectivity when completing staff reviews
• Self-motivated and resourceful with the ability to multitask and successfully operate in a fast paced, team environment
• Ability to work well individually and in a team environment
• Strong analytical and organizational skills
• 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
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Ability to meet assigned deadlines and work under minimal supervision and with all levels of staff and management.
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

Working Conditions

• Work Schedule: Night Shift (M - F 9PM - 5AM) following US hours
• Work Setup: Onsite
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.