Healthcare Claims Quality Analyst
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Job Description
Healthcare Claims Quality Analyst conducting audits to ensure compliance in medical claims processing. Join Evry Health’s remote claims operations team to exceed member and provider expectations.
Responsibilities:
- Evry Health is seeking a Healthcare Claims Quality Analyst to support our claims operations team.
- The Quality Analyst will perform in-depth audits of medical claims processing to ensure payment accuracy, healthcare compliance, and adherence to plan benefits and industry regulations.
- Conduct detailed quality audits on complex medical claims, disputes, payment adjustments, and medical claim adjudication decisions.
- Exceed member and provider expectations through excellent quality results.
- Report on trends and training opportunities.
- Develop a rebuttal process to ensure errors are appropriately assigned.
- Create monthly KPI report that summarizes results, top error trends and recommendations for closing any gaps.
Requirements:
- You have a minimum of 3-5 years commercial health plan experience
- You have 2-3 years’ experience performing claims auditing or quality review functions.
- You have expertise in medical claims adjudication and healthcare claims processing
- You are familiar with healthcare compliance requirements and claim processing regulations
- You have a solid knowledge of medical and insurance industry terminology.
- You are an excellent communicator, both verbally and in writing and can articulate and communicate complex topics to a broad audience.
- You can perform comfortably in a fast-paced, deadline-oriented work environment.
- You possess strong attention to detail and problem-solving skills with a high level of accuracy.
- You are not afraid to express new ideas or suggestions for improving processes.
- You are skilled at identifying and implementing tools to improve the claims quality assurance process, including QA reporting and tracking mechanisms to allow easy identification of trends or quality issues.
- You collaborate with and support business and operational units across the organization.
- You are proficient in Microsoft Office applications Word, Excel, Outlook, OneNote, etc.
- You have prior experience using a CRM, preferably Salesforce.
Benefits:
- Competitive salary
- Comprehensive health, dental, and vision insurance as well as life and disability
- Retirement savings plan with company match
- Generous time off/vacation
- Professional development opportunities
- Flexible and remote work environment
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