Quality & Process Analyst

Description

JOB SUMMARY

Responsible for conducting audits to measure Quality Assurance across critical business processes. Complete analytical assessment of work product and processes to identify root cause of incidences, provide recommendations for workflow process modifications and provide feedback to key stakeholders. Prepare reports to communicate QA results and findings to Leadership Team and process owners across the organization, driving accountability and ongoing improvement of QA metrics. Interface with internal customers to act as a functional and operational liaison for the end user group community. Understand policies and procedures and utilize them for daily Quality Assurance duties. The QA analyst will be responsible for documenting, and monitoring business processes and associated workflow.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Complete quality assurance inspections as required, ensuring standardization and compliance with established policies and procedures and applicable regulations. Identification of root cause(s) of workflow/process incident management.
• Identify critical process opportunities for enhancement and propose tangible solutions to avoid repeatable errors then collaborate with internal and external business partners (Operations, Compliance, Facilities, Payers) to drive accountability and process improvements
• Prepare and review data and QA reporting with key stakeholders.
• Provide input for policies and procedures updates as required.
• Special projects as assigned

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to review and audit recorded work effort on claims and phone calls to review items such as inaccurate payment postings, contractual adjustments, reclassification of accounts, denied claims, debits, credits and appeals.
• Ability to understand operational business processes, and apply technical/system knowledge
• Will review critical business processes, primarily Billing, Collections, Dispute and Denial Management, Credits, Pre-Legal and Revenue Analytics for government and non-government operations.
• Ability to work independently to meet objectives in a repetitive auditing environment.
• Possesses an exceptional eye for detail and process improvement.
• Ability to identify problems, gather and analyze information skillfully and provide recommendations for process improvements.
• Independent, logical thinker with ability to perform detailed data analysis
• Strong organizational, customer service, interpersonal, and time-management skills
• Demonstrated ability to build strong working relationships with key internal and external stakeholders (Centralized Operations, Compliance, Facilities) and be a thought leader/influencer for change.
• Advanced troubleshooting abilities, with ability to problem solve complex technical issues
• Must demonstrate excellent professional communication skills through clearly written, concise and comprehensive documentation; strong technical writing skills
• Must be capable of executing and publishing written requirements utilizing the business intent and goals, while providing technical details to support workflow or system development
• Ability to develop and/or present training to operations trainers and/or business users
• Intermediate level skills in applications such as Microsoft Excel, Word, and Visio
• Additional skills preferred, not required:
  • Knowledge of healthcare revenue cycle
  • Knowledge/experience with system design in a database environment
  • Knowledge of project management methodologies
  • Knowledge of research methodology, principles, and procedures

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• BA/BS Preferred or 3-5 years equivalent experience in Healthcare Revenue Cycle
• 3-5 years of Supervisory or Management experience in healthcare billing, cash collections, cash application, or denial management.
• Extensive knowledge on critical business processes, primarily Billing, Collections, Dispute and Denial Management for different line of businesses (Medicare, Medicaid, Managed Care, etc.).
• Medical billing and claims experience with an understanding of healthcare reimbursement process.
• Working knowledge of critical systems such as ACE, VI Web, On Demand, PBAR, MedAssets, Epremis and workflow.
• Strong computer skills, and intermediate skill level in Microsoft Office applications (Word and Excel) is required.
• Medical billing and claims experience with an understanding of healthcare reimbursement processes.
• Working knowledge of electronic billing, Hardcopy billing, UB-04s, ICD-9 codes, and CPT codes.
• Trained in HIPAA guidelines.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone.
• Includes ability to type, sit for long periods of time, view claims on a computer, and listen to phone calls through headphones.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office work environment
• Moderate office noise

OTHER

• Ability to travel 5% of time

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $22.56 - $33.85 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.