8 Claims Quality Assurance Analyst Jobs in Houston, TX
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Claims Quality Assurance Analyst
$64k-80k (estimate)
Full Time | Ancillary Healthcare
1 Month Ago
Apex Health Solutions is Hiring a Claims Quality Assurance Analyst Near Houston, TX
Summary: Position is responsible for developing and conducting monthly Quality Assurance (QA) Audits to determine claim processing/payment accuracy in accordance with health plan benefit design and established desktop procedures. This position is responsible for providing reports/presentations outlining findings, trends, and corrective actions needed within processing systems or with staff training.Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Establishes QA auditing protocol to evaluate accuracy of claim processing.
- Conducts monthly QA audits of adequate sample size on a timely basis.
- Creates documentation/reports/presentations on processing accuracy, trends, and areas for improvement.
- Conducts weekly QA audits of 10 to 15 claims per Claims Analyst to evaluate accuracy.
- Provides direct feedback to claims analyst with error findings, correct processes, and request mitigation.
- Creates documentation/reports on each staff member’s accuracy/trends/areas of improvement and provides to Manager/Sr Manger monthly with limited direction, translates regulatory and business requirements to technical specifications for claims configuration including process documentation.
- Perform root cause analysis on identified errors; collaborate with other stakeholders to develop mitigation plans.
- Utilizes a detailed understanding of insurance, processes, and business systems to drive the research and analysis of the defined problem, design the recommended solution, and implement the solution, while addressing associated change management.
- Strong knowledge of health insurance industry with all product lines (Medicare, Medicaid, Commercial, ASO, DSNP, etc…)
- Extensive knowledge of claims policies and procedures including regulatory requirements and industry standards from AMA, CMS and CCI edits.
- Strong computer skills, specifically with Microsoft Office and Windows.
- A desire to serve others while being empathetic with the drive to go above and beyond to help resolve questions at the first point of contact.
- Must have a strong work ethic and a sense of responsibility to other team members and external stakeholders to meet all needs represented by a robust sense of accountability
- Adaptable and a quick learner, willing to change to meet shifting customer and business needs.
- Excellent verbal and written communication skills
- Extremely organized and detail-oriented.
- The ability to develop effective working relationships, and work collaboratively with all levels of staff, vendors, and partners.
- Ability to work independently on a variety of projects in a high volume, fast paced, and sometimes nebulous environment
- Demonstrated pattern of growth in ability to lead, motivate, develop and mentor others
- Solid business acumen, decision making, research and analytical skills
Job Summary
JOB TYPE
Full Time
INDUSTRY
Ancillary Healthcare
SALARY
$64k-80k (estimate)
POST DATE
03/10/2024
EXPIRATION DATE
05/10/2024
WEBSITE
apexhws.com
HEADQUARTERS
LAKELAND, FL
SIZE
25 - 50
TYPE
Private
CEO
ROBERT A BLACKBURN
REVENUE
<$5M
INDUSTRY
Ancillary Healthcare
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