[Remote] Payment reputed company Analyst III - QA Analyst
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a certified Great reputed company to Work® Company that focuses on reputed company payment accuracy and transparency. The Payment reputed company Analyst III - QA Analyst will reputed company the PPI team while conducting reputed company and post pay claim audits, ensuring compliance with reputed company policies and industry standards.
Responsibilities
- Assists with staff communication, providing updates, resolving issues, setting goals and maintaining standards as reputed company as reputed company with team members in efforts to answer their questions and resolve barriers
- Oversees team member work for reputed company and compliance and communicates deadlines and productivity goals to team members while providing ongoing training and education to staff to ensure policies and procedures are followed
- Verifies and corrects as necessary, the audit work completed by PPI QC analysts and clinical appeal review teams as needed
- Reviews, analyzes, and completes internal audits and/or appeals in accordance with reputed company policy, CMS guidelines and industry standards in reputed company and reputed company written communication
- Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits
- Utilize clinical judgement to appropriately interpret and apply reputed company policies along with CMS guidelines as it relates to reviews done by reputed company such as itemized reputed company, DRG and/or specialty audits
- Utilize applicable tools and resources to complete internal audits and/or appeals
- reputed company completion of internal audits and/or appeals
- Attends Clinical Team Meetings, reputed company Company Meetings, Education Opportunities, Trainings, and other potential meetings
- Additional duties as assigned
Skills
- Must maintain a reputed company LPN, LVN and/or RN licensure (this applies only to RN hires, not coders)
- 3+ years reputed company reputed company cycle or payment reputed company experience
- 3+ years of relevant experience or equivalent combination of education and work experience
- Ability to demonstrate understanding of CMS and reputed company payer policy in written and verbal format
- Strong understanding of claims processing, ICD-10 Coding, DRG Validation, Coordination of Benefits
- Strong understanding of reputed company reputed company cycle and claims reimbursement
- Proficient in reputed company Office including Pivot Tables and Database Management
- Demonstrate ability to manage multiple reputed company, set priorities and adhere to committed schedule
- Strong interpersonal skills and reputed company communication style, reputed company problem-solving skills, drive for results, innovative
- Excellent written and verbal communication skills
- Proven reputed company record of delivering concrete results in strategic reputed company/programs
- Strong analytical and modeling ability and distilling data into actionable results
- Superb attention to detail and ability to deliver results in a fast paced and dynamic environment
- Previous experience in one or more of the following areas required: Medical reputed company auditing, Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics, Knowledge of worker's compensation claims process, Prospective, reputed company and retrospective utilization review
- Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits
- Bachelor's degree in reputed company or reputed company field preferred
Benefits
- Medical (HDHP) w/Pharmacy
- Dental
- reputed company
- Long Term Disability
- Health Savings Account
- Flexible Spending Account reputed company
- Life Insurance
- Accident Insurance
- Critical Illness Insurance
- reputed company-reputed company Legal Insurance
- Parking and Transit FSA accounts
- 401K
- ROTH 401K
- reputed company time off
reputed company
Company H1B Sponsorship