JOB DESCRIPTION: Sr. Executive: Credit Balance - Quality Analyst
JOB SUMMARY: As a QA RCM, you will be responsible for auditing the work of RCM analysts to ensure the highest standards of service delivery.
REQUIRED EDUCATION/EXPERIENCE:
- Should be a Graduate
- Should have worked as a Quality Controller for Credit Balance for at least one year with medical billing service providers or should have minimum 2+ years experience into Credit Balance
- Must have very good knowledge of medical billing and be confident in process knowledge.
- Experience in the end-to-end Healthcare process for the audit
- Adapting to new situation challenges whenever required.
- Adhere to all company policies and procedures.
YEARS OF EXPERIENCE:
- 5 Years of experience in end-to-end Insurance credit balance function
- Minimum 2 year of experience on paper as Quality Analyst.
POSITION RELATIONSHIPS:
- Reports directly to the Assistant Manager
JOB RESPONSIBILITIES:
- Review the work performed by Credit Balance team and document any quality issues.
- Review call quality issues on various parameters such as conversational skills, claims resolution, and voice quality.
- Participate in developing process documentation.
- Provide feedback and work with the training team to provide remedial training.
- Always be at the forefront of ethical behavior and never be a bystander.
PROFESSIONAL:
- Recognize and respect cultural diversity.
- Adapt communication to an individual's ability to understand. . Use medical terminology appropriately.
- Respond to communications received within a reasonable time frame.
- Project a professional manner and image.
- Adhere to ethical principles.
- Demonstrate initiative and responsibility.
- Work as a team member.
- Efficient Time Management.
- Prioritize and perform multiple tasks.
- Adapt to change, including new hours of operation and methodology.
- Attend functional team meetings and mandatory in-service education.
- Maintain proper observation and adherence to company policies and procedures.
KNOWLEDGE, SKILLS, AND EXPERIENCE:
- Should have worked as a Quality Controller for Credit Balance for at least one year or should have worked more than 2 years into Credit Balance.
- Must have very good knowledge of AR and be confident in process knowledge.
- Experience in the end-to-end Healthcare process
- Adapting to new situation challenges whenever required.
- Adhere to all company policies and procedures
LEGAL and COMPLIANCE:
- Maintain patient and company confidentiality.
- Practice within the scope of education, training, and personal capabilities.
- Document company documents (hard copy and electronic) accurately.
- Use appropriate guidelines for releasing information.
- Maintain awareness of US federal and US state health care legislation and regulations, PHI, HIPAA
WORKING HOURS:
- 40 hours per week as Full-time employee
- Shift time: 01:30AM TO 10:30PM IST
- Weekends Off
TELECOMMUTER/INTERNET REQUIREMENT:
- High Speed internet connection at home, must be broadband with minimum of 100 MBPS Speed or above
- Must understand and adhere with telecommuter policy
- Must have power backup at to mitigate power outage
