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