Quality Control Analyst - Medical Reviewer

Role Description Overview:

The QC is accountable to manage day to day activities of Denials Processing/ Claims follow-up/ Customer Service and Ensuring that project related quality processes are followed by associates, client specific metrics and internal metrics are achieved, provide coaching to employees, track and trend data for improvement

 Responsibility Areas:

1. Participate in client calls and understand the quality requirements both from process perspective and for targets
2. Identify a method to achieve the quality targets and implement the same in consultation with operations manager / Team Manager
3. Collect data on individual transactions (chart, claim, EOBs etc) on the errors
4. Provide face to face feedback and also send emails with the type of errors etc. on daily basis
5. Coach employees to minimize errors and improve performance
6. Provide inputs to the training team on common mistakes made to enhance training curriculum
7. Test files/batches for new clients/processes to be processed as part of familiarization
8. Generation of QA reports on a daily basis
9. Attainment of Internal & External SLA as per Process Defined.
10. Strict adherence to the company policies and procedures.

• Extensive Quality experience Audits, Coaching & training as per process defined.
• Min of 1.5 Yrs of Professional and Relevant Experience
• Sound knowledge in Healthcare concept.
• Excellent Communication skills Verbal & Non Verbal
• Critical problem solving and issue resolution
• Must have Good Product and Process Knowledge
• Must have good analytical and judgmental skills
• Quality Feedback/Refresher sessions 
• Prepare and Maintain Quality status reports