Quality Analyst - Medical Bill Review (Remote) 2023-1273
Company: Managed Care Advisors
Location: Bethesda
Posted on: May 17, 2023
Job Description:
Orlando, FL, USA Operations Full TimeRemote Quality Analyst -
Medical Bill Review - Nation-Wide PositionIF YOU CARE, THERE'S A
PLACE FOR YOU HEREOverview Are you looking to make a difference by
providing appropriate and timely medical bill audit reviews for
members of the World Trade Center Health Program, including
survivors and the brave responders impacted by the September 11th
terrorist attacks? Would you like to be part of a talented team of
quality assurance and join our team of energetic and caring
people?As a Sedgwick Government Solutions remote Quality Analyst -
Bill Review, you will work from your home office, and ensure World
Trade Center Health Program members' medical claims are processed
timely and meet the quality standard in accordance with Program
Regulations and Guidelines. You will work with quality management
nurses to identify and process complex bills to meet the
appropriate treatment based on industry standards and
Program-related conditions. In this process, you will use our
proprietary quality review system.Quality Analyst - Bill Review
Responsibilities
- Conducts Claims audits to ensure claims processors:
- o Identifies and escalates complex bills per documented
guidelines.
- o Codes provider bills in accordance with program
guidelines
- o Pay providers in an accurate and timely manner
- Conducts pre-payment and post-payment audits within Bill Review
to ensure compliance with state guidelines, rules, regulations, and
performance guarantees.
- o Provides consistent reporting and communication with respect
to audit findings in all areas of operations within Sedgwick Bill
Review.
- o Leads Quality audits specific to Bill Review vendors,
independent operational units, as well as client specific.
- o Provides random quality audits of our Provider Customer
Service Center to ensure accuracy and quality outcomes.
- Provides input to SGS managers and teams regarding analysis,
updates, and recommendations for modifications for procedures and
processes to continually improve operations and protocols.
- Assist with the collection and summary of data in collaboration
with SGS Quality Committees, identifies opportunities for
improvement, and present findings.
- Understands each contract's clinical quality assurance
requirements and monitors compliance, in collaboration with the SGS
analytics and management teams.
- Performs standard and ad hoc audits of claims activities, as
directed by quality committees.Quality Analyst - Bill Review
Qualifications
- Bachelor's degree or equivalent experience and education
required.
- At least five (5) years of medical bill review or claims
processing experience or an equivalent combination of education and
experience is required. Knowledge of medical terminology is
preferred.
- At least three (3) years of experience with Quality Management
including project management, quality improvement, corrective
action, auditing, and/or staff education.
- Federal Employees Compensation Act (FECA) experience,
preferred.
- Medicare/Medicaid rules and regulations experience,
preferred.
- Excellent oral and written communication
- PC literate, including Microsoft Office products
- Detail-oriented, strong analytical and organizational
skills
- Strong organizational skills
- Good interpersonal skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
- U.S. Citizenship
- Prior to hiring and training must be able to pass a preliminary
credit and background checkFor a career path that is both
challenging and rewarding, join Sedgwick Government Solution's
talented team. Taking care of people is at the heart of everything
we do. Our clients depend on our talented colleagues to take care
of their most valuable assets-their employees, and their customers.
At Sedgwick Government Solutions, caring counts -. Join our team of
creative and caring people of all backgrounds, and help us make a
difference in the lives of othersIn addition to a competitive
salary, comprehensive health and welfare benefits, and incentive
compensation, Sedgwick Government Solutions offers participation
and vesting in a 401(k) plan with a company match. If you would
like to contribute to our important mission and work collegially in
a professional organization that values intelligence, integrity,
and initiative, consider a career with Sedgwick Government
Solutions.To be considered for this position, please submit a
resume, and complete the application.The information provided above
has been designed to indicate the general nature and level of work
of the position. It is not a comprehensive inventory of all duties,
responsibilities, and qualifications required. Important
Information Successful candidates will be required to undergo a
financial and criminal background check and obtain and maintain
confidential-level security clearance upon hire. We participate in
the United States Federal Government E-Verify program to confirm
the employment authorization of the employee upon hire. Search Firm
Representatives Please be advised that Sedgwick Government
Solutions (Government Solutions) is not seeking assistance or
accepting unsolicited resumes from search firms for this employment
opportunity. Regardless of past practice, a valid written agreement
and task order must be in place before any resumes are submitted to
Government Solutions. All resumes submitted by search firms to any
employee at Government Solutions without a valid written agreement
and task order in place will be deemed the sole property of
Government Solutions and no fee will be paid in the event that
person is hired by Government Solutions.Government Solutions
strives to make our career site accessible to all users. If you
need a disability-related accommodation for completing the
application process, please contact Government Solutions regarding
accommodations. Sedgwick Government Solutions is an Equal
Opportunity and Affirmative Action Employer All qualified
applicants will receive consideration for employment without regard
to age, citizenship status, color, disability, marital status,
national origin, race, religion, sex, sexual orientation, gender
identity, veteran status, or any other classification protected by
federal state or local laws as appropriate, or upon the protected
status of the person's relatives, friends or associates.Sedgwick
Government Solutions abides by the requirements of 41 CFR
60-741.5(a) . This regulation prohibits discrimination against
qualified individuals on the basis of disability and requires
affirmative action by covered prime contractors and subcontractors
to employ and advance in employment qualified individuals with
disabilities.Sedgwick Government Solutions abides by the
requirements of 41 CFR 60-300.5(a) . This regulation prohibits
discrimination against qualified protected veterans and requires
affirmative action by covered prime contractors and subcontractors
to employ and advance in employment qualified protected
veterans.About SedgwickSedgwick Government Solutions is a fully
owned subsidiary of Sedgwick. Sedgwick is a leading global provider
of technology-enabled risk, benefits, and integrated business
solutions. Taking care of people is at the heart of everything we
do. Millions of people and organizations count on Sedgwick each
year to take care of their needs when they face a major life event
or something unexpected happens. The company provides a broad range
of resources tailored to client's specific needs in casualty,
property, marine, benefits, and other lines. At Sedgwick, caring
counts; through the dedication and expertise of more than 27,000
colleagues across 65 countries, the company takes care of people
and organizations by mitigating and reducing risks and losses,
promoting health and productivity, protecting brand reputations,
and containing costs that can impact the bottom line.
www.sedgwick.com PI216400430
Keywords: Managed Care Advisors, Bethesda , Quality Analyst - Medical Bill Review (Remote) 2023-1273, Healthcare , Bethesda, Maryland
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