Quality Auditor- Healthcare Industry

2 weeks ago

Mohali Punjab, India Neo-Crew Technologies Full time

**Job description**

**Greetings from Neo crews Technology healthcare and RCM,**

Individuals in this role will audit review portals on behalf of Provider for open accounts in the system (proprietary and client system)for better quality result. In addition they also resolve inquiries from other

departments regarding the incomplete, underpaid claims and perform activities in accordance with the

status of the claim like rebilling, appeal filing etc.

**Key Responsibility**:
Achieve Individual SLA targets set as well the account level targets set for the team on the

quality metrics:. Auditing accounts and ensuring timely correction within defined TAT

**Quality** - Completion of activity as per agreed quality level defined by client with respect to the

information received or provided on the calls
- Conduct first-level quality audits on vendor End to end RCM results.
- Identify provider query opportunities and create compliant queries.
- Ensure adherence to RCM Guidelines and CMS guidelines.
- Perform retrospective quality reviews and concurrent review audits.
- Identify issues and trends in RCM and documentation.
- Provide input and feedback on audit results.
- Recommend process improvements.

**First Call Resolution (FCR) - Number of calls/Inquiries closed in the first call (Right First Time)**

100% Compliance to Process Adherence as defined in the SOP with respect to any specific inbound

scripts for inbound calls 100% compliance on the regulatory and audit requirements,

Ensure compliance of all process requirements is not less than 100%

Complete all mandatory assessment/ certifications as applicable to the lines of business

**Key Skills**:

- Good Communication Skills
- Listening & Comprehension
- Medical coding, demographic entry, insurance eligibility check, charge entry, payment posting to

patient account, denial management/resolution, outbound calling to insurance payers
- Multi speciality Billing would be an added advantage
- exposure in GE Centricity Portal, Cerner, EPIC Nextgen Aethna would be preferred

**Minimum Eligibility**:
Any graduate, Minimum Work Experience Required: Minimum Work Experience Required: Minimum 3

year in US healthcare RCM
- Six sigma green belt would be an added qualification

**# Benefits**
- 5 Days working from the office
- Teamwork
- Career opportunity
- Learning new skill development
- Night shift
- Fun Friday

Schedule:

- Monday to Friday
- Morning shift

Neo crews technology D-178, 4th Floor, Phase 8B Industrial area

Schedule:

- Monday to Friday

Work Location: In person

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