Quality Analyst - Outpatient Medical Coding (IVR/SDS) - WFH

Join our dynamic team and make a meaningful impact in the healthcare industry. You'll play a pivotal role in ensuring accurate claims processing while advancing your career in a supportive and innovative environment. 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!

Fulltime Permanent Remote

Fixed Weekends Off

Day 1 HMO with 2 of your dependents covered for FREE

Group Life Insurance

Medical Cash Allowance

Rice Allowance

Clothing Allowance

Holiday Gift

Bereavement Assistance

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

Proficient computer skills including Microsoft Office Suite, intermediate Excel skills required

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 Setup: Remote

Work Schedule: Monday - Friday 7AM - 3PM or 11AM - 7PM

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.