Quality Expert

2 months ago


Mumbai, India IKS Health Full time

 Expertise in medical billing end to end RCM
 Knowledge on EPIC, eCW, NextGen, IMS, Raintree applications is an added advantage.
 Strong knowledge on process to initiate authorization and basic understanding of Medical
records. Should have worked on various authorization scenarios and able to take immediate
action to resolve them and follow up with Insurance to obtain authorization timely.
 Should have strong verbal and written communication skills.
 Monitor and analyze RCM process errors
 Responsible for calling insurance companies in USA on behalf of doctors/physicians and follow
up on authorization
 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 identify and report issues front end/client that have resulted in delay in
authorization
 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


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