Quality Analyst

As a Quality Analyst, your role involves supporting quality auditing, analysis, reporting, and developing plans to achieve positive outcomes. You will work on risk identification, diagnosing issues, identifying process improvement solutions, and implementing improvement methods. Continuous engagement and collaboration with the Operations and Training Team is essential for success. Key Responsibilities: - Ensure that project-related quality processes are followed by denials analyst and that client-specific and internal metrics are achieved - Prepare detailed reports on audit findings and understand quality requirements from both process and target perspectives, delivering reports in a timely manner - Identify methods to achieve quality targets and implement them in consultation with QCA lead and/or managers, assisting with the Quality Assessment process - Participate in performance improvement activities and continuing education to enhance knowledge and skills - Share relevant information with the team, taking initiative to ensure project completion - Participate in client presentations of findings when requested - Adjust workloads as necessary to successfully complete projects - Handle complaints, questions, and queries as needed - Disseminate changes in guidelines and rules, monitor changes in laws and regulations to ensure compliance - Foster teamwork and service excellence within the department - Participate in meetings to address performance and training recommendations, ensuring improvement suggestions are implemented - Assist in new hire training and refresher trainings - Maintain compliance with all company policies and procedures - Educate staff on outcomes and correction plans through presentations - Perform other necessary duties - Protect and disclose patient protected health information in accordance with HIPAA standards - Understand and comply with Information Security and HIPAA policies at all times Qualifications: - Experience in training new users - Knowledge of medical coding such as EOBs, CPT & ICD-9 & 10 codes, HCFAs, UB92s, HCPCS, DRGs, and authorizations/referrals - Understanding of healthcare revenue cycle operational processes - Experience with practice management systems, preferably EPIC PB, Allscripts, and/or Cerner - Familiarity with denied claims and appeals process - Proficient in navigating multiple software and computer applications - Detail-oriented, well-organized, and capable of maintaining objectivity in staff reviews - Strong computer skills including Microsoft Office Suite and intermediate Excel skills - Self-motivated, resourceful, and able to multitask in a fast-paced team environment - Strong analytical, organizational, and interpersonal skills - Problem-solving abilities with sound judgment and decision-making skills - High level of integrity, dependability, and results-oriented mindset - Ability to meet deadlines, work under minimal supervision, and communicate effectively at all levels of the organization - Excellent written and verbal communication skills with a customer service-oriented personality Please note the working conditions include occasional physical demands, mental demands related to collaboration and stress handling, and a minimal noise level in the work environment.,