Quality Expert

Minimum 2 years of experience in RCM domain in US Health, preferably in Quality
Auditor/Expert capacity in Accounts Receivables.
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