Quality AssuranceAssociate III
Medata
Date: 3 weeks ago
City: Mandaluyong City
Contract type: Full time
Job Track Description
- Performs tasks based on established procedures.
- Uses data organizing and coordination skills to perform business support or technical work.
- Requires vocational training, certifications, licensures, or equivalent experience.
- Proficiency within a range of analytical or operational processes.
- Completes atypical assignments.
- Works within established procedures and practices.
- May establish the appropriate approach for new assignments.
- Acts as a resource for colleagues.
- Completes work with limited supervision.
- Has developed skillset in a range of processes, procedures, and systems.
- Understanding of how teams integrate and work best together to support the achievement of company goals.
- Impacts a team, by example, through the quality service and information provided.
- Uses discretion to change work procedures and practices.
- May provide guidance and support to junior team members.
- Provides solutions to atypical problems based on existing precedents or procedures.
- Exchanges information and ideas effectively.
- Reviews specialized Medical Bills including hospital, surgery, and high-level physician bills.
- Establishes the appropriateness of a final reimbursement outcome by making the distinction between and knowing when to apply either Fee Schedule reduction, PPO reduction, Usual and Customary reduction, or Medicare reduction.
- Communicates and upholds the basis for the methodology used to accomplish the reduction of charges.
- Analyzes and reviews high-level office visits, reports, and record reviews.
- Interprets hospital review guidelines for both inpatient and outpatient claims.
- Conducts test studies for the compliance team, requiring high-quality results and strict deadlines.
- Performs other duties as assigned.
- Complies with all policies and standards.
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