Quality Controller

1 day ago

Chennai, Tamil Nadu, India EXL SERVICES Full time ₹ 9,00,000 - ₹ 12,00,000 per year

Senior Executive

JOB DESCRIPTION: RCM Denial Management - AR Caller – Quality - Sr Executive

JOB SUMMARY: As a QA RCM, you will be responsible for auditing the work of RCM Callers to ensure the highest standards of service delivery.

REQUIRED EDUCATION/EXPERIENCE:

  • Should be Graduate
  • Should have worked as a Quality Controller for AR for at least one year with medical billing service providers or should have minimum 5 years' experience into AR
  • Must have very good knowledge of medical billing and be confident in process knowledge.
  • Experience in the end-to-end Healthcare process and AR team for the audit
  • Adapting to new situation challenges whenever required.
  • Adhere to all company policies and procedures.

POSITION RELATIONSHIPS:

  • Reports directly to the Assistant Manager

JOB RESPONSIBILITIES:

  • Review the work performed by AR team and document any quality issues.
  • Review call quality issues on various parameters such as conversational skills, claims resolution, and voice quality.
  • Participate in developing process documentation.
  • Provide feedback and work with the training team to provide remedial training.
  • Check the reports developed by AR team - aging analysis, understanding days in A/R, top reasons for denials, etc
  • Always be at the forefront of ethical behavior and never be a bystander.

PROFESSIONAL:

  • Recognize and respect cultural diversity.
  • Adapt communication to an individual's ability to understand.
    • Use medical terminology appropriately.
  • Respond to communications received within a reasonable time frame.
  • Project a professional manner and image.
  • Adhere to ethical principles.
  • Demonstrate initiative and responsibility.
  • Work as a team member.
  • Efficient Time Management.
  • Prioritize and perform multiple tasks.
  • Adapt to change, including new hours of operation and methodology.
  • Attend functional team meetings and mandatory in-service education.
  • Maintain proper observation and adherence to company policies and procedures.

KNOWLEDGE, SKILLS, AND EXPERIENCE:

  • Should have worked as a Quality Controller for AR for at least one year with AR providers or should have worked more than 6 years into AR
  • Must have very good knowledge of AR and be confident in process knowledge.
  • Experience in the end-to-end Healthcare process and AR Team for the audit
  • Adapting to new situation challenges whenever required.
  • Adhere to all company policies and procedures

LEGAL and COMPLIANCE:

  • Maintain patient and company confidentiality.
  • Practice within the scope of education, training, and personal capabilities.
  • Document company documents (hard copy and electronic) accurately.
  • Use appropriate guidelines for releasing information.
  • Maintain awareness of US federal and US state health care legislation and regulations, PHI, HIPAA

WORKING HOURS:

  • 40 hours per week as Full-time employee
  • Shift time: 01:30AM TO 10:30PM IST
  • Weekends Off

TELECOMMUTER/INTERNET REQUIREMENT:

  • High Speed internet connection at home, must be broadband with minimum of 100 MBPS Speed or above
  • Must understand and adhere with telecommuter policy
  • Must have power backup at to mitigate power outage

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