Quality Auditor

Job Title:

Quality Analyst

Work Location:

Chennai

Department / Vertical:

Capability Development

Reports To:

Quality Manager

Duties & Responsibilities:

• Audit the received request for prior authorizations through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored.

• Audit the Process of referrals and submit medical records to insurance carriers to expedite prior authorization processes.

• Monitor the correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.

• Audit the medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.

• Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.

• Review denials and follow up with the provider to obtain medically necessary information to submit an appeal of the denial.

• Audit the prioritization of the incoming authorizations by level of urgency to the patient.

• Maintains knowledge and education to remain current, efficient, and productive as a home care insurance and payer resource to the branch.

• Demonstrates self-direction to prioritize and accomplish job responsibilities.

• Participates in the after-hours on-call process to ensure client care policies and procedures are followed and staffing issues are resolved.

• Keeping Skills Alive – Production on live account for dedicated hours a week

• Audit the Auditor as applicable.

Work Experience Requirement:

• Min 3 years’ RCM & Prior-Authorization experience

Qualification:

• Any Graduate / Postgraduate

Additional Comments:

• Disciplined, Positive attitude, & Punctuality.

• Strong interpersonal skills, good communication skills, and ability to effectively work with and train employees, both freshers and experienced. Should have an aptitude to learn new things. Ability to read, write, and perform basic computer operation. Must be a self -starter, highly motivated, organized, and able to prioritize.

Job Title:

Quality Analyst

Work Location:

Chennai

Department / Vertical:

Capability Development

Reports To:

Quality Manager

Duties & Responsibilities:

• Audit the received request for prior authorizations through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored.

• Audit the Process of referrals and submit medical records to insurance carriers to expedite prior authorization processes.

• Monitor the correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.

• Audit the medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.

• Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.

• Review denials and follow up with the provider to obtain medically necessary information to submit an appeal of the denial.

• Audit the prioritization of the incoming authorizations by level of urgency to the patient.

• Maintains knowledge and education to remain current, efficient, and productive as a home care insurance and payer resource to the branch.

• Demonstrates self-direction to prioritize and accomplish job responsibilities.

• Participates in the after-hours on-call process to ensure client care policies and procedures are followed and staffing issues are resolved.

• Keeping Skills Alive – Production on live account for dedicated hours a week

• Audit the Auditor as applicable.

Work Experience Requirement:

• Min 3 years’ RCM & Prior-Authorization experience

Qualification:

• Any Graduate / Postgraduate

Additional Comments:

• Disciplined, Positive attitude, & Punctuality.

• Strong interpersonal skills, good communication skills, and ability to effectively work with and train employees, both freshers and experienced. Should have an aptitude to learn new things. Ability to read, write, and perform basic computer operation. Must be a self -starter, highly motivated, organized, and able to prioritize.