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Company

Cognizant · 2 hours ago

Healthcare Accounts Receivable Quality Assurance Analyst

Ijamsville, MD

Full-time

Remote

Mid Level

$17/hr - $23/hr

4+ years exp

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ConsultingIndustrial Automation

No H1B

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Responsibilities

Auditing a sample of claims worked by the team from the Accounts Receivable report.

Identifying denial trends and analyzing the root cause of physician payer denials.

Making recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency to reduce denials and underpayments.

Tracking and trending claim denials and underpayments to identify initiatives for payer, process or technology improvement plans.

Creating Error Parameters based on the Client guidelines.

Conducting Root cause analysis on all errors & publishing the findings.

Providing clear and effective Feedback on top errors and coaching the team members on the corrective and preventive actions.

Speaking in a group setting as well as individually, on a daily, weekly, and monthly frequency.

Confidently presenting Error trends to the client, as well as any queries for clarification before the client.

Participating in monthly calibration sessions with operations & clients, discussing audit sheets and changes on need basis with the operations & clients.

Combining daily audits, summarizing the error trends, and tracking associate wise Quality performance.

Qualification

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Claim Denial ResolutionRARCCARC CodesMedical Billing ExperienceState/Federal Billing GuidelinesReimbursement MethodologiesTechnical Payer PoliciesQuality AssuranceRoot Cause AnalysisExcel SkillsPowerPoint Skills

Required

Thorough working knowledge on resolving physician claim denials.

Responsible for auditing a sample of claims worked by the team from the Accounts Receivable report.

Ability to identify denial trends and analyze the root cause of the physician payer denials.

Familiarity with procedures impacted by National Correct Coding Initiative Edits (NCCI), technical payer policies, appeal documentation and resolution.

Working knowledge of various RARC and CARC codes, and how to work them to resolution for reimbursement.

Demonstrates knowledge and expertise in state/federal billing guidelines, reimbursement methodologies, and payer policies.

Makes recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency to reduce denials and underpayments.

Tracks and trends claim denials and underpayments to identify initiatives for payer, process or technology improvement plans.

Ability to create Error Parameters based on the Client guidelines.

Ability to conduct Root cause analysis on all errors & publish the findings.

Strong Communication Skills- both verbal & written, to provide clear and effective Feedback on top errors and coach the team members on the corrective and preventive actions.

Comfortable speaking in a group setting as well as individually, on a daily, weekly, and monthly frequency.

Ability to confidently present Error trends to the client, as well as any queries for clarification before the client.

Participate in monthly calibration sessions with operations & clients, discuss audit sheets, changes on need basis with the operations & clients.

Analytical & Problem-solving skills.

Strong Excel skills to combine daily audits, summarize the error trends, track associate wise Quality performance.

Education: Associates degree or equivalent from two-year College or technical school or six months to one-year related experience and/or training or equivalent combination of education and experience.

4-8 Yrs. Work experience in a Hospital/Doctor’s Office setting/Medical Billing Company, with specific working knowledge on resolving Physician claims.

Legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.