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Operations QC Analyst in Los Angeles, CA at TeamHealth

Date Posted: 11/10/2018

Job Snapshot

Job Description

Join a team of dynamic, results oriented professionals!

Named among “The World’s Most Admired Companies" by Fortune Magazine
Named among "America's 100 Most Trustworthy Companies" by Forbes magazine
Named among “Great Places to Work" by Becker’s Hospital Review

  • Career Growth Opportunities
  • Convenience market on site
  • Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
  • 401K program (Discretionary matching funds available)
  • Employee Assistance Program
  • Referral Program
  • Dental plans & Vision plans
  • GENEROUS Personal time off
  • Eight Paid Holidays per year
  • Quarterly incentive plans
  • Business casual dress code
  • Free Parking
  • Free coffee daily
  • Employee of the month awards with monetary gift and parking space
  • Training Programs
  • Fitness Center with personal trainer on site
  • Awesome Facility with terrific amenities
  • Wellness programs
  • Flexible work schedule

JOB DESCRIPTION OVERVIEW:

Under direct supervision, the QC Analyst is responsible for quality control and process review for Centricity business. The position is responsible for: ensuring reports are submitted, running and analyzing reports, and identifying errors. The QC Analyst carries out his/her duties by adhering to the highest standards of ethical and moral conduct, and acts in the best interest of TeamHealth.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Responsible for running daily/weekly reports to determine quality, trends, and preventive measures for the North Hollywood Billing Center.
  • Monitors, reviews and escalates and issues related to the new CB exception reports, FSC Mapping reports, Zirmed claim rejections, TES edits, and all reports from Centricity Business related to all North Hollywood Billing Center departments.
  • Tracks all outstanding projects they are assigned to.
  • Coordinates with and provides feedback to the Senior Operations Manager and Lead regarding quality and process improvements that affect the department and facilitates solutions and recommendations. Ensures compliance with state and federal laws and regulations for Commercial, Medicare, Medicaid, Managed Care and self-pay payers
  • Maintains ongoing knowledge of HCFA 1500 and other mandatory state billing forms and filling and follow up requirements and ensures compliance of CPT, HCPCS and ICD-9/ICD-10 coding regulations and guidelines.
  • Continually seeks to understand and act upon customer needs, concerns, and priorities. Meets customer expectations and requirements, and gains customer trust and respect.
  • Functions effectively within a team and participates and contributes constructively to produce results in a cooperative effort.
  • Demonstrates ongoing enthusiasm and commitment to the work assigned.
  • Participates in a process to continually improve organizational effectiveness using self-assessment performance evaluation criteria.
  • May perform special assignments and other related tasks as assigned.

 

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • Normally, the knowledge, skills and abilities necessary for adequate job performance can be obtained through approximately Five+ years’ experience with insurance analysis, denial and collections processes within a multi-facility environment.
  • In addition, working knowledge of insurance carriers’ payment regulations including various reimbursement schemes, coinsurance, deductibles and contractual adjustments is necessary as well as significant working knowledge of the insurance process, denials, appeals and insurance eligibility.
  • Advanced knowledge of Microsoft Excel. Also, demonstrated success working in a team environment focused on meeting organization goals and objectives is necessary. Experience with providing visible participation and support of major change initiatives preferred.
  • Some college coursework in business administration or accounting preferred.
  • Knowledge of basic math and the ability to perform math functions in units of American currency.
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form.
  • Ability to review documents for accuracy and reasonability.
  • Ability to determine priorities
  • Ability to coordinate schedules and information.
  • Ability to conduct mathematical and financial analysis
  • Ability to work well under pressure.
  • Tact and patience when dealing with individuals at all levels, both within and outside the company.
  • Commitment to TeamHealth values
  • Ability to communicate effectively orally, in person and on the telephone, and in writing, with individuals at all levels, both within and outside the company.
  • Knowledge of coordination of benefits requirements and processes.
  • Knowledge of health insurance requirements and follow up procedures.
  • Knowledge of insurance rejection/denial processing to perform follow up activity.
  • Knowledge of writing, reviewing and submitting written appeals to health plans.
  • Ability to multi-task, set priorities and follow through without direct supervision.
  • Ability to type efficiently and accurately.
  • Ability to operate a computer (i.e., Microsoft Office Professional) efficiently and accurately.
  • Ability to operate various office machines (i.e., fax, copier).
  • Ability to work well in a team environment and be flexible in problem solving environment. 

PHYSICAL / ENVIRONMENTAL DEMANDS:

  • Have good attendance.
  • Work at a desk, utilizing a computer.
  • Communicate by telephone.
  • Operate a PC and other office equipment (copier, fax, etc.).
  • Move freely between offices.
  • The work environment corresponds to the average office environment.

 

DISCLAIMER:

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.

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