Quality Expert Job in Iks Health

Job Description

• Minimum 2 years of experience in RCM domain in US Health, preferably in Quality Auditor/Expert capacity in Payment Posting.
• Should be able to analyze ERA and manual posting, patient-cash, check, and credit card payments.
• Should have strong understanding of medical billing terms, such as co-pays, deductible allowable amount, co-insurance, contractual adjustment, in-network and out-of-network processing, retraction, recoupment, and offsetting, capitation payments, collection agency payments, MVA and WC payments, correspondence, and zero claims.
• Should be able to access and navigate through various websites to retrieve, process, and track EOBs and if require correct and upload EOBs.
• Should be able to identify line item details for non-covered services, inclusive services, credentialing, medical necessity, non-par, no authorization denials, COB denials, and associated denial reason/remark codes.
• Should have good understanding on CARC and RARC codes.
• Medicare claims processing-sequestration, interest payment, reporting codes, and modifiers.
• Should be able to understand payer-specific guidelines, secondary and tertiary claims and patient statement process, and patient and insurance refunds.
• Should be capable of interpreting and processing the EOBs/ERAs, research, correct and refile denied claims, if required.
• Should have strong analytical skills on reconciliation, payment variance, and balances with insurance or patients.
• Should have strong verbal and written communication skills.
• Should have good feedback/coaching and mentoring skills.
• Should have hands-on experience in MS Excel and Google Suite experience is preferred.
• Knowledge of Six Sigma Quality Tools is an added advantage.
• Should be able to analyze the trends, perform RCA, and propose solutions around the identified root causes.
• Knowledge on eCW, NextGen, IMS, Raintree applications is an added advantage.
• Should be flexible with shift timings based on business requirement.