Quality Revenue Analyst - Must have Claims Exp. in MCO

Do you have 3 years of experience in a Managed Care Organization?

Must have 3 years of basic claims experience and 1 year of advanced claims processing...

 

Including reversals, appeals, grievances, special handling, analysis, and research.  Must have working knowledge of Medicaid, Medicare, and Self-funded commercial insurance.

 

Summary Objectives:

 

You will be responsible for conducting random and focused quality reviews of keyed claims to insure compliance within department.  Maintain data from quality review activities in an online format and identify/make recommendations for corrective action.  You will complete quality audits by maintaining department minimum standards adn maintaining accurate and timely input of quality review data online. 

 

Knowledge/Skills:

 

You must have exceptional oral and written communication skills, attention to detail, and ability to multi-task/possess strong organizational skills.  Capacity to establish and maintain constructive business relations internally and externally while maintaining integrity and confidentiality.  Aptitude to research, analyze and successfully review broad spectrum of issues.