Outpatient Coding Auditor
Affordable Housing Trust for Columbus and Franklin County
Senior Quality Assurance Analyst
SmartLight Analytics
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- Perform quality reviews of Quality Analyst work products
- Review claims data and confirm proper referral case presentation including referral reason, logic for the reason and proposed corrective action
- Compare work with client SPD and industry best practices and validate identified savings values
- Provide feedback to analysts on errors, omissions, or opportunities for improvement
- Contribute to QA standards documentation and serve as a resource for Quality Analysts
- Analyze trends in quality issues and implement root cause/corrective actions
- Support creation of a "culture of quality" among the clinical operations team
- Collaborate with healthcare professional consultants, clinical teams, business analysts, data scientists and engineers to refine analytics tools and understand stakeholder data needs
- Present findings and insights to internal teams, clients, and stakeholders
- Ensure quality, accuracy, and integrity of clinical data by conducting data validation, cleaning, and preparation
- Identify and resolve issues related to data discrepancies, missing data, or inconsistencies within clinical datasets
- Act as final checkpoint before findings are released to clients and carriers; report to Manager of Payment Integrity
Requirements
- 3-5 years’ work experience related to healthcare billing, claims adjudication, fraud investigation, payment integrity operations and/or healthcare reimbursement
- Strong knowledge of clinical terminology, medical procedures, and healthcare workflows
- Strong critical thinking and writing skills
- Experience with manipulating and analyzing large datasets
- Ability to be concise, independent and provide defensible decisions in writing
- Must have solid ability to accurately document findings in written form
- Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills
- Strong PC knowledge and skills, including all Microsoft Office products
- 3-5 years’ experience with CPT and HCPCS code terminology
- Certified Coding Specialist (AAPC or AHIMA) preferred
- Bachelor’s degree in nursing or related field preferred
- 3+ years of experience working in the group health business or in a healthcare provider’s practice preferred
- Intermediate knowledge of Local, State & Federal laws and regulations pertaining to health insurance (commercial health plans and/or dental plans) preferred
- Experience with data analysis as it relates to healthcare claims adjudication preferred
- Must be a legal resident of the United States of America (position only eligible for U.S. legal residents)
- Applicants local to the DFW area are required to work at the SmartLight HQ office 1 day per week (must agree if local)
