Quality & Process Analyst

JOB SUMMARY 

Responsible for conducting audits to measure Quality Assurance across critical business processes. Complete analytical assessment of work product and processes to identify root cause of incidences, provide recommendations for workflow process modifications and provide feedback to key stakeholders. Prepare reports to communicate QA results and findings to Leadership Team and process owners across the organization, driving accountability and ongoing improvement of QA metrics. Interface with internal customers to act as a functional and operational liaison for the end user group community. Understand policies and procedures and utilize them for daily Quality Assurance duties. The QA analyst will be responsible for documenting, and monitoring business processes and associated workflow.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Complete quality assurance inspections as required, ensuring standardization and compliance with established policies and procedures and applicable regulations. Identification of root cause(s) of workflow/process incident management.
• Identify critical process opportunities for enhancement and propose tangible solutions to avoid repeatable errors then collaborate with internal and external business partners (Operations, Compliance, Facilities, Payers) to drive accountability and process improvements
• Prepare and review data and QA reporting with key stakeholders.          
• Provide input for policies and procedures updates as required. 
• Special projects as assigned

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to review and audit recorded work effort on claims and phone calls to review items such as inaccurate payment postings, contractual adjustments, reclassification of accounts, denied claims, debits, credits and appeals.
• Ability to understand operational business processes, and apply technical/system knowledge 
• Will review critical business processes, primarily Billing, Collections, Dispute and Denial Management, Credits, Pre-Legal and Revenue Analytics for government and non-government operations.
• Ability to work independently to meet objectives in a repetitive auditing environment.
• Possesses an exceptional eye for detail and process improvement.
• Ability to identify problems, gather and analyze information skillfully and provide recommendations for process improvements. 
• Independent, logical thinker with ability to perform detailed data analysis
• Strong organizational, customer service, interpersonal, and time-management skills
• Demonstrated ability to build strong working relationships with key internal and external stakeholders (Centralized Operations, Compliance, Facilities) and be a thought leader/influencer for change.
• Advanced troubleshooting abilities, with ability to problem solve complex technical issues 
• Must demonstrate excellent professional communication skills through clearly written, concise and comprehensive documentation; strong technical writing skills
• Must be capable of executing and publishing written requirements utilizing the business intent and goals, while providing technical details to support workflow or system development
• Ability to develop and/or present training to operations trainers and/or business users
• Intermediate level skills in applications such as Microsoft Excel, Word, and Visio 
• Additional skills preferred, not required:
  • Knowledge of healthcare revenue cycle 
  • Knowledge/experience with system design in a database environment 
  • Knowledge of project management methodologies
  • Knowledge of research methodology, principles, and procedures

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.  This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. 

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• BA/BS Preferred or 3-5 years equivalent experience in Healthcare Revenue Cycle 
• 3-5 years of Supervisory or Management experience in healthcare billing, cash collections, cash application, or denial management.