15 days old

ANALYST, QUAL & PROCESS

Conifer Health Solutions
Frisco, TX 75034

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

JOB SUMMARY

Responsible for conducting audits to measure Quality Assurance across critical business processes. Complete analytical assessment of work product and processes to identify root cause of incidences and provide feedback to key stakeholders. Prepare reports to communicate QA results and findings to Leadership Team and process owners across the organization, driving accountability and ongoing improvement of QA metrics. Interface with internal customers to act as a functional and operational liaison for the end user group community. Understand policies and procedures and utilize them for daily Quality Assurance duties. Use The QA analyst will be responsible for documenting, and monitoring business processes and associated workflow.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

  1. Complete quality assurance inspections as required, ensuring standardization and compliance with established policies and procedures and applicable regulations.
  2. Identify, research and document process improvement opportunities. Then collaborate with internal and external business partners (Operations, Compliance, Facilities, Payers) to drive accountability and process improvements
  3. Prepare and review data and QA reporting with key stakeholders.
  4. Provide input for policies and procedures updates as required.
  5. Special projects as assigned



    Qualifications:

    KNOWLEDGE, SKILLS, ABILITIES

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    • Ability to review and audit recorded work effort on claims and phone calls to review items such as inaccurate payment postings, contractual adjustments, reclassification of accounts, denied claims, debits, credits and appeals.
      • Will review critical business processes, primarily Billing, Collections, Dispute and Denial Management, Credits, Pre-Legal and Revenue Analytics for government and non-government operations.

        • Ability to work independently to meet objectives in a repetitive auditing environment.

          • Possesses an exceptional eye for detail and process improvement.

            • Ability to identify problems, gather and analyze information skillfully and provide recommendations for process improvements.

              • Independent, logical thinker with ability to perform detailed data analysis

                • Demonstrated ability to build strong working relationships with key internal and external stakeholders (Centralized Operations, Compliance, Facilities) and be a thought leader/influencer for change.

                  • Advanced troubleshooting abilities, with ability to problem solve complex technical issues

                    • Must demonstrate excellent professional communication skills through clearly written, concise and comprehensive documentation; strong technical writing skills

                      • Must be capable of executing and publishing written requirements utilizing the business intent and goals, while providing technical details to support workflow or system development

                        • Ability to develop and/or present training to operations trainers and/or business users

                          • Intermediate level skills in applications such as Microsoft Excel, Word, and Visio

                            • Additional skills preferred, not required:

                              • Knowledge of healthcare revenue cycle

                                • Knowledge/experience with system design in a database environment

                                  • Knowledge of project management methodologies

                                    • Knowledge of research methodology, principles and procedures

                                      EDUCATION / EXPERIENCE

                                      Include minimum education, technical training, and/or experience preferred to perform the job.

                                      • BA/BS Preferred or 3-5 years equivalent experience in Healthcare Revenue Cycle
                                        • 3-5 years of Supervisory or Management experience in healthcare billing, cash collections, cash application, or denial management.

                                          • Extensive knowledge on critical business processes, primarily Billing, Collections, Dispute and Denial Management for different line of businesses (Medicare, Medicaid, Managed Care, etc.).

                                            • Medical billing and claims experience with an understanding of healthcare reimbursement process.

                                              • Working knowledge of critical systems such as ACE, VI Web, On Demand, PBAR, MedAssets, Epremis and workflow.

                                                • Strong computer skills, and intermediate skill level in Microsoft Office applications (Word and Excel) is required.

                                                  • Medical billing and claims experience with an understanding of healthcare reimbursement processes.

                                                    • Working knowledge of Electronic billing, Hardcopy billing, UB-04s, ICD-9 codes, and CPT codes.

                                                      • Trained in HIPAA guidelines.
                                                        Job: Conifer Health Solutions
                                                        Primary Location: Frisco, Texas
                                                        Job Type: Full-time
                                                        Shift Type: Days

                                                        Categories

                                                        Posted: 2019-10-02 Expires: 2019-11-01

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ANALYST, QUAL & PROCESS

Conifer Health Solutions
Frisco, TX 75034

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