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QA/ Process Specialist - RCM

QA/ Process Specialist - RCM

Huron

3 - 8 years

7 - 8 Lacs

Bengaluru

Posted:1 day ago| Platform:

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Skills Required

Claims System maintenance MIS Analytical Billing Employee engagement Healthcare Powerpoint Auditing Business operations

Work Mode

Work from Office

Job Type

Full Time

Job Description

Join our team as the expert you are now and create your future.

As an RCM QA/ Process Specialist, you will be responsible for team handling, audits, work allocation, client interactions and generate distribute RCM metrics reports to the leadership team.
Excellent communication skills, attention to detail, and strong technical and problem solving skills are essential aspects of this role.

Thorough understanding of RCM processes like Billing, Cash Posting, Credit Balance, Accounts Receivables, Denial Management & Correspondence review
Very good understanding of RCM metrics like Days in AR, Ageing above 90 days, Collections and bad debt Perform Quality checks/audits on all claims processed as per quality policy or as per client SOP Responsible for getting the claims processed in compliance to the billing rules mentioned and ensure all errors are identified in QA and actions initiated before the claim is rebilled to the insurance Implement Lean Six sigma mythologies to improve the accuracy of the processes Consistently review the audit parameters and modify as per the necessary requirement Prepare daily, weekly & monthly audit metrics reports and share it with leadership Conduct analysis and present summary of findings to leadership in a clear, concise, convincing and actionable format Establish a strong relationship with Team Leaders / Managers by demonstrating the gaps, trends & patterns identified during the data/report compilation Suggest ways of improvements and set up calibration sessions with onshore and internal teams Develops documentation of quality related MIS work to have smooth operations and easy system maintenance QUALIFICATIONS: 3+ years of RCM industry experience 2+ year Experience in relevant RCM functions performing quality audits Hands on experience in reporting with proficiency in MS Excel and MS PowerPoint Strong ability to analyze raw data, draw conclusions and develop actionable recommendations Ability to handle multiple tasks of reporting simultaneously Ability to adapt quickly to new and changing technical environments as well as strong analytical, problem solving and quantitative abilities. Solid verbal and written communication skills are required. Education/Certifications:
Graduate Any quality related certifications like Lean Six Sigma can be an added advantage

Position Level Associate

Country India

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QA/ Process Specialist - RCM