Quality Analyst, Contract Reimbursement Analysis

US Acute Care Solutions

25d • $22 - $40 • Remote

About The Position

The Quality Analyst is responsible for performing quality and training audits on completed tasks, including software applications, SOPs, and other resources. Supports continuous education initiatives by assisting with training content and monitoring new and upcoming state and federal Independent Dispute Resolution (IDR) regulatory changes. Collaborates closely with Contract Reimbursement Analysis (CRA) team members, Team Leads, and Management to document and implement best practices.

Requirements

• Demonstrates the ability to learn rapidly and adapt quickly to new processes and technology.
• Uses logic and analysis to solve problems and offers useful solutions appropriate for the situation at hand.
• Knowledge of medical insurance and its terminology.
• Knowledge of and skill in using personal computers and terminals in a Windows environment.
• Proficiency with external programs including Athena, OnBase, Intellicred, and web-based portals.
• Proficiency with Excel, Word, and Adobe.
• Ability to pay close attention to detail.
• Ability to identify, research and solve problems and discrepancies.
• Ability to communicate with coworkers, management, and third-party payers in a courteous and professional manner.
• Ability to maintain confidentiality.
• Ability to work effectively in a remote setting.
• Ability to work overtime when needed.
• High school diploma or equivalent; post-secondary course work preferred.
• At least one year of experience in payer contracting or RCM related roles.

Responsibilities

• Performs quality audits for the CRA state and federal arbitration process, both for department staff and offshore vendors, to ensure completed tasks are meeting IDR policies, following known strategies and best practices, while using applicable resources appropriately.
• Recognizes coaching opportunities and works with department staff and offshore team members to develop necessary skills.
• Creates, updates, and maintains spreadsheets to track monthly audit information and report on quality results.
• Assists with developing and performing on-going training/support programs customized for new hire training as well as continuing education training for existing department staff and offshore team.
• Assists with managing updates to existing training materials and developing new resources by evaluating department needs.
• Researches payer and Independent Dispute Resolution Entity (“IDRE”) trends, making recommendations to improve IDR success rate and monitor success of strategy changes.
• Assists department director and manager with additional CRA team audits as needed.
• Performs and assists with other department duties as needed.

What This Job Offers

• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees