QA Auditor Level I

MedRisk; Conshohocken (Montgomery County); On-site; USD 42,000 - 52,000; Full time

Job summary

MedRisk in Conshohocken, PA is seeking a QA Auditor to join our 9:00 am–5:00 pm office-based team. You will audit provider HCFAs and UBs against re-priced MedRisk-generated EOBs or HCFAs before mailing, ensuring accuracy and quality across all bills.

You’ll identify trends, manage backlogs, and support process improvement while training colleagues and collaborating with QA and CDT teams to uphold high standards.

Qualifications

• Detail-oriented with strong organizational, time management and problem-solving abilities.
• Preferred extensive knowledge of general Workers Compensation billing procedures including knowledge of CPT Coding, ICD-10, and HCPC.
• Strong organizational, time management and project management skills with multi-tasking abilities.
• Ability to multi-task, adapt quickly to change and follow projects through completion
• MS Office Products; Word, Excel and Outlook experience

Responsibilities

• Audit all Workers Compensation bills re-priced through “Medata or Bridge”.
• Meet/exceed audit productivity and quality standards to maintain the integrity of the claim/bill.
• Maintain and report individual and team claim/bill backlogs, ensuring that all claims are QA’d within printed receive dates, audited within objective 2 days TAT goal.
• Determine error sources and accurate entry of claim audits, document with accuracy in QA Printing Production Excel log kept on Folks2 drive
• Interpret and understand MedRisk carrier contracts “CQ” and basic knowledge of state guidelines compliance, and HIPPA regulations.
• Review error trend reports and participate in rebuttal process for continuous improvement; providing feedback to Quality Assurance and CDT teams.
• Provide one-on-one training as needed with associates and actively participate in Quality Assurance Team meetings.
• Perform focused audits, working with varying types of data.
• Complete other clerical or support duties as assigned.
• Lead by example, demonstrate good promptness and adhere to company policies for yearly attendance.

Skills

Detail-oriented

Time management

Problem-solving

Communication

Tools

Excel

Word

Outlook

Job description

This position will be in our Conshohocken, PA office 5 days a week, hours 9:00 am to 5:00 pm.

Position Summary

• The QA Team audits critical fields on all provider HCFAs & UBs against re-priced MedRisk Generated EOBs or MedRisk Generated HCFAS before mailing.
• Trends are observed, identifying key systematic issues.
• QA team offers above standard quality on all bills before mailed.
• Confirming accuracy of billing data, routinely interacts with medata application for re-pricing incorrect bills.

Primary Duties & Responsibilities

• Audit all Workers Compensation bills re-priced through “Medata or Bridge”.
• Meet/exceed audit productivity and quality standards to maintain the integrity of the claim/bill.
• Maintain and report individual and team claim/bill backlogs, ensuring that all claims are QA’d within printed receive dates, audited within objective 2 days TAT goal.
• Determine error sources and accurate entry of claim audits, document with accuracy in QA Printing Production Excel log kept on Folks2 drive
• Interpret and understand MedRisk carrier contracts “CQ” and basic knowledge of state guidelines compliance, and HIPPA regulations.
• Review error trend reports and participate in rebuttal process for continuous improvement; providing feedback to Quality Assurance and CDT teams.
• Provide one-on-one training as needed with associates and actively participate in Quality Assurance Team meetings.
• Perform focused audits, working with varying types of data.
• Complete other clerical or support duties as assigned.
• Lead by example, demonstrate good promptness and adhere to company policies for yearly attendance.

Qualifications

• Detail-oriented with strong organizational, time management and problem-solving abilities.
• Preferred extensive knowledge of general Workers Compensation billing procedures including knowledge of CPT Coding, ICD-10, and HCPC
• Strong organizational, time management and project management skills with multi-tasking abilities.
• Manage multiple priorities, maintain confidentiality, and display a courteous, patient, and helpful attitude toward employees.
• Basic understanding of HIPPA policies and procedures.
• Ability to multi-task, adapt quickly to change and follow projects through completion
• MS Office Products; Word, Excel and Outlook experience