Quality Assurance Analyst

Description

PRINCIPAL DUTIES AND RESPONSIBLITIESSubject matter expert for claims handling and provider dataResearch claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause and resolution of payment errorApply all policies and procedures based on client specific guidelines toeach claim auditDocument quality review outcome and provide feedback audit feedback to leadershipInvestigate and resolve claim inquiries / audits in a timely manner, providing writtencorrespondence and ensuring all nonstandard claims are handled appropriatelyPerform research to support quality review findings, exceptions, and issue resolutionParticipate in the creation of new exceptions and business rules, process improvement suggestions, and improved data miningEnsure accurate data entry and timely follow up on tasks that support our inventory workflow and reporting capabilitiesCollaborate with the Training Department to identify training opportunities and support creation of training curriculumUnderstand and maintain HIPAA confidentiality and privacy standards when completing assignmentsWork with QA Manager to identify, develop, and implement new processes to assist with tracking claim audit quality reviewsParticipate in department and company meetings as requestedComplete special projects as assignedQUALIFICATIONSEducation and CertificationsBachelors degree preferred but not requiredCertified Professional Coder (CPC