Quality Assurance - Healthcare Account | Nigh Shift | Flexible Work Arrangement - #129814


Date: 2 weeks ago
City: Pasay, Metro Manila
Contract type: Full time
Audits & Quality Assurance Coordinator

Essential Duties:
Working with the Customer Care, Revenue Cycle Management, Clinical, Sales and Finance departments, the Medicare Audits & Quality Assurance (QA) Coordinator is responsible for post service review of patient medical records, team members’ phone communications, transactions and productivity to ensure proper processing of orders, confirmation, billing and collections. The Medicare Audits & QA Coordinator is also responsible for preparing, drafting and submitting responses to various departments, management teams or auditing agencies on matters of quality adherence and medical review.

Responsibilities & Duties:
· Performs daily quality assurance audits (phone communications and document management system workunits) of our Customer Care and Revenue Cycle Management departments
· Provides monthly productivity and quality assurance reports to Customer Care Department
· Reviews patient medical records for services provided
· Research and documents steps taken and transactions processed by SuperCare Health teams
· Research and documents medical necessity and justification for services provided
· Draft requests and inquiries, as well as letters of medical necessity to different departments at SuperCare Health, physicians, hospitals, and medical groups
· Process internal chart audits, report findings and recommend improvements and changes
· Receives, reviews, researches on, prepares and submits documentation in response to external audits
· Prepares and submits documentation to all level of appeals in response to unfavorable decisions by auditing agencies
· Assists with patient and referral surveys and inquiries
· Manages and distributes patient complaints
· Attends all departmental meetings, company meetings, and in-services
· Understand and adheres to all of company policies
· All other appropriate tasks identified and assigned by the Audits & QA Manager

Required Experience/Knowledge:
· Candidate must possess at least a Bachelor’s Degree/College Degree in Nursing, Medicine, Medical Science, or equivalent (Licensure not required)
· At least 1 year of working experience in the related field
· Must have knowledge of diagnosis and medical terminologies
· Demonstrated ability to review patient medical records and determine morbidities, limitations and needs
· Effective written and verbal communication skills
· Knowledge of patient confidentiality and HIPAA compliance regulations
· Excellent interpersonal and customer relationship skills with the ability to work in a very fast-paced environment, learn new concepts quickly and independently
· Strong organizational skills, detail oriented and must have analytical thinking
· Computer literate with very good knowledge of MS Office, PDF Applications, and Google Suite
· Typing speed of at least 40 wpm

Preferred Experience/Education:
· Experience in working for healthcare, medical, or home medical equipment/pharmacy industry
· Experience in medical billing and/or medical coding
· General knowledge of Medicare, Medicaid and Private insurance billing and qualification tools and guidelines

What's in it for you:
-Competitive Salary
-HMO plus qualified dependent
-Life Insurance

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