Quality Expert

3 weeks ago

Mumbai, India IKS Health Full time

Minimum years of experience in RCM domain in US Health, preferably in Quality Auditor/Expert capacity in Payment Posting. Should be able to analyze ERA and manual posting, patient-cash, check, and credit card payments. Should have strong understanding of medical billing terms, such as co-pays, deductible allowable amount, co-insurance, contractual adjustment, in-network and out-of-network processing, retraction, recoupment, and offsetting, capitation payments, collection agency payments, MVA and WC payments, correspondence, and zero claims. Should be able to access and navigate through various websites to retrieve, process, and track EOBs and if require correct and upload EOBs. Should be able to identify line item details for non-covered services, inclusive services, credentialing, medical necessity, non-par, no authorization denials, COB denials, and associated denial reason/remark codes. Should have good understanding on CARC and RARC codes. Medicare claims processing-sequestration, interest payment, reporting codes, and modifiers. Should be able to understand payer-specific guidelines, secondary and tertiary claims and patient statement process, and patient and insurance refunds. Should be capable of interpreting and processing the EOBs/ERAs, research, correct and refile denied claims, if required. Should have strong analytical skills on reconciliation, payment variance, and balances with insurance or patients. Should have strong verbal and written communication skills. Should have good feedback/coaching and mentoring skills. Should have hands-on experience in MS Excel and Google Suite experience is preferred. Knowledge of Six Sigma Quality Tools is an added advantage. Should be able to analyze the trends, perform RCA, and propose solutions around the identified root causes. Knowledge on eCW, NextGen, IMS, Raintree applications is an added advantage. Should be flexible with shift timings based on business requirement.

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