Quality Analyst - Prior Authorization

JOB DESCRIPTION

Designation/ Role: Quality Analyst

Department: Pre Auth

Work Timing: Night Shift

Qualifications: Any Graduate

Skills:

A successful candidate must have proficient knowledge/capabilities in the following areas:

1. Claims management and/or customer service experience desired.
2. Bachelors degree preferred, or any equivalent combination of education and experience.
3. Ability to perform at a high level of productivity and quality.
4. Capacity to maintain a high level of accuracy.
5. Excellent written and oral communication skills required to represent Infinx Clients.
6. Computer skills including Microsoft Office Suite.
7. Skills to work independently and be resourceful with the ability to multitask.

Experience

3+ years’ experience in AR/Pre Auth process.

Job Responsibilities

• Should possess a complete knowledge and understanding of AR/Pre Auth process, software and Quality guidelines of the client’s program assigned.
• Random Transactional Monitoring – Ensuring systematic Quality check of previous day’s production i.e. Analysis of account, calling analysis, correct follow up, required action taken and updated software, updated productivity report.
• Identifying errors critical to process such as wrong analysis results in incorrect follow up, Incorrect or incomplete information captured on call, Incorrect or incomplete action taken, incomplete production report.
• Ensure the Quality score for the process and Payment Posting callers of the team more than 98% or should meet as per the client expectations.
• Ensure the team must be aware of criticality of Fatal and non-fatal parameters/errors.
• Ensuring the error must be communicated to associate and process owners. Associate provided constructive feedback about the error committed and corrected.
• Ensuring that Corrective Action Policy is adhered to and Improvements seen on individuals being audited.
• Ensure that every week team will be briefed about the major errors committed towards process. Team must be coached about the correct follow ups related to those errors.
• Weekly/Monthly Quality performance report to be mailed to internal client on time. Reports generated must be error free.
• Maintaining the Quality Metrics i.e. Process quality score, Individual quality score, number of errors, Corrective Action policy, Categorization of associates, documentation of Fatal errors, Improvement plans, Process Knowledge Test etc.
• Responsible for random transaction audits and performance of new hires during OJT/Nesting period.