Quality Analyst

Job Purpose

The Quality Analyst is responsible for supporting quality auditing, analysis, reporting, and the development of strategic plans that drive positive outcomes. This role involves identifying risks, diagnosing issues, proposing process improvement solutions, and implementing these improvements based on sound principles. Continuous engagement and collaboration with the Operations and Training Teams are crucial for success.

Duties & Responsibilities

• Ensure project-related quality processes are adhered to by denials analysts and that client-specific and internal metrics are met.
• Prepare comprehensive reports detailing audit findings, demonstrating a clear understanding of quality requirements from both a process and target perspective. Ensure timely delivery of these reports.
• Develop and implement methods to achieve quality targets in consultation with the QCA lead and/or managers. Assist with the Quality Assessment process to ensure all quality standards and targets are met.
• Participate in performance improvement activities and engage in continuing education to maintain current credentials and enhance knowledge and skills.
• Share relevant information with the team and take initiative to ensure project completion for all team members.
• Participate in client presentations of findings as requested.
• Adjust workloads as necessary to ensure the successful completion of projects.
• Address and resolve complaints, questions, and queries as required.
• Disseminate changes in guidelines and rules; monitor changes in laws, regulations, and policies impacting clinical documentation and reimbursement to ensure compliance.
• Foster an environment of teamwork and service excellence within the department.
• Participate in conference calls and 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 assigned.
• Use, protect, and disclose patients' protected health information (PHI) strictly 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 the viewing of PHI to the absolute minimum necessary to perform assigned duties.

Qualifications

• A minimum of 2 years of previous work experience as a Quality Analyst within healthcare insurance collections, self-pay collections, customer service in a call center setting, or in compliance and/or training.
• Experience in training new users.
• Proficiency with EOBs, CPT & ICD-9 & 10 codes, HCFAs, UB92s, HCPCS, DRGs, and authorizations/referrals.
• A strong understanding of fundamental healthcare revenue cycle operational processes, including insurance functions, patient billing & collections, Managed Care, Medicare, Medicaid, and Commercial Practices.
• Experience with practice management systems; EPIC PB, Allscripts, and/or Cerner are preferred.
• Knowledge of the denied claims and appeals process.
• Must have experience in outbound transaction AR processes (Payers).
• Ability to navigate through multiple software and computer applications efficiently.
• Detail-oriented and highly organized with a strong capacity for maintaining objectivity during staff reviews.
• Proficient computer skills, including intermediate Microsoft Excel skills.
• Self-motivated and resourceful, with the ability to multitask and thrive in a fast-paced, team-oriented environment.
• Ability to work effectively both independently and as part of a team.
• Strong analytical and organizational skills.
• Excellent interpersonal skills with the ability to communicate effectively at all levels of the organization.
• Strong problem-solving and creative skills, with the ability to exercise sound judgment and make informed decisions based on accurate and timely analyses.
• High level of integrity and dependability, with a strong sense of urgency and a results-oriented approach.
• Ability to meet assigned deadlines and work under minimal supervision, collaborating with staff and management at all levels.
• Excellent written and verbal communication skills.
• A gracious and welcoming personality conducive to customer service interactions.

Working Conditions

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 computers, computer peripherals, and telephones; extend arms; kneel; talk and hear.

Mental Demands

The employee must be able to follow directions, collaborate with others, and manage stress effectively.

Work Environment

The noise level in the work environment is typically minimal.