Quality Expert

Job Description

Minimum 2 years of experience in RCM domain in US Health, preferably in Quality Auditor/Expert capacity in Accounts Receivables. Expertise in medical billing end to end RCM Strong knowledge on various denials and remark codes and able to take immediate action to resolve them and follow up on the claims for collection of payment Monitor and analyze RCM process errors Audit error corrections both short- and long-term Quantify error rates and their trends individually, by team, by client, and by client pool Analyze the errors to build training materials and tests Create automation solutions to reduce error rates Should be able to resolve billing issues that have resulted in delay in payment Responsible for call/data quality monitoring Provide feedback to agents using the prescribed feedback model Mentoring and coaching agents on process-level issues Monitor adherence to compliance procedures and processes Responsible for reporting program-level quality scores to the process owners Responsible for conducting calibration and performance review calls in terms of quality with clients as well as the internal team Conduct refresher training on the basis of the errors identified Perform weekly analysis aiming at improving SLA Perform brainstorming and root cause analysis to analyze data and provide tips or suggestions to the operation/management team Identify and highlight potential risk areas and recommend preventive action Maintaining a robust monitoring system to ensure key program metrics are adhered to and the required level of quality is maintained across the board