Quality Analyst / Auditor (RCM - US Healthcare)

Responsibilities:

• Complete audit analysis and reports at the individual, department and division level based on defined position pathways and individual / department performance and quality metrics.
• Identify specific individual and department training needs and opportunities for performance improvement through a defined audit analysis program and assist in ongoing process improvement opportunities through audit analysis.
• Audit work in the Charge Entry, Payment Posting and Collections Departments to determine compliance with Policies and Procedures.
• Provide follow up review of policy changes and implementation of those changes into audit process and reporting.
• Maintain current knowledge of Medicare, Medicaid, Work Comp guidelines and rules.
• Assist with internal and external compliance audits, account reviews on an as-needed basis.
• Work with process improvement team to improve quality and performance through process improvement initiatives.

Requirements:

• In-depth knowledge of Medicare, Medicaid, Workers Compensation guidelines and requirement
• In-depth knowledge of the MSI patient accounting system and report writing
• In-depth knowledge of chronic/acute pain billing
• Detailed audit approach and methods for testing accuracy and compliance to defined billing guidelines
• Analytical skills to summarize audit findings into statistically meaningful reports
• Ability to work effectively and independently with staff, physicians, and external customers
• Must have strong keyboard skills with knowledge of Microsoft Word, Excel and PowerPoint
• Must have a pleasant disposition and high tolerance level for diverse views
• Excellent verbal and written communication skills