Quality Executive

4 days ago

Pune, India Cotiviti Full time

Overview:
Responsibilities:

- Responsible for quality monitoring o

Responsible for quality monitoring on claims/cases/transactions and/or telephonic interactions
- Provide feedback to auditors/clinical team members using prescribed feedback model
- Mentoring and coaching auditors on process level issues.
- Monitor adherence to compliance procedures and processes.
- Responsible for reporting program level quality score to the process owners.
- Responsible for conducting calibration and performance review call in terms of quality with the internal team. (Initially will be assisting the senior quality analyst, training and guidance will be provided to be able to lead such meetings in future).
- Conduct refresher training on the basis of the errors identified.
- Communicate process updates by conducting a session as and when required.
- Maintaining update log and sharing it with the team on a regular basis.
- Perform brainstorming and root cause analysis to analyze data and provide tips or suggestions to operations/management team.
- Identify and highlight potential risk areas and recommend preventive action..

ATTRIBUTES AND BEHAVIORS
- Develops and maintains positive working relationships with others.
- Shares ideas and information.
- Assists colleagues unprompted.
- Takes pride in the achievement of team objectives.
- Has credibility with peers and senior managers.
- Self-motivated - driven to ac

Self-motivated - driven to achieve results.
- Works with a sense of urgency.
- High customer service ethic - is passionate about meeting customer expectations and improving service levels.
- Keeps pace with change - acquires knowledge/skills as the business evolves.
- Handles confidential information with sensitivity.
- Exhibits behaviors consistent with Cotiviti Values:
RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS
- CIC or CCS certified coder/clinician with prior DRG experience
- Clinicians with CPC certification & prior QA experience (minimum 1 year). Willing to complete CIC within 3-4 months of joining
- Clearance of all major exams (SSC, HSC, qualifying degree).
- College degree mandatory.
- Experience in US healthcare.
- 2 Years of experience working in a similar setup
- Computer proficiency in Microsoft Office (Word, Excel, Outlook); Access preferred

SKILLS & COMPETENCIES
- Excellent communication skills (written and verbal)
- Excel proficiency.
- Ability to work well under pressure and meet deadline.
- Ability to work on multiple projects simultaneously.

JOB DEMANDS/ LOCATION
- Location -Preferably Pune (open to Coimbatore). Will be required to come to Pune for 3-4 months during the training and OJT period
- Training/OJT will be during US daytime (3-4 months)
- Occasional requirement to travel (primarily related to training and Company meetings) within India/US
- Ability to work seated at a computer for long periods of time

KEY CONSTITUENTS
- No Direct Reports
- Internal
- Quality Manager and Team Leader.
- Operations Manager and Team Leader.
- Production Resources.
- External - Clients and Onshore Business Partners

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