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Quality Analyst-Medical Coding Review
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MET Healthcare Solutions
Remote
$49,920 Salary, Full-Time
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Job Description
MET Healthcare Solutions is a healthcare management group headquartered just north of the Heights in Houston, Texas. At MET Healthcare Solutions, our goal is to provide the highest quality services by combining industry best practices with the industry's best staff. Come join our team as a Medicolegal Review Quality Analyst (QA) to begin making a difference in the healthcare industry. The QA is responsible for auditing medical reviews (coding and medical necessity) determinations to ensure compliance with the metrics and criteria surrounding the process. As a QA, you will work with internal teams of attorneys, medical coders, and other QA auditors to monitor and review determinations that will directly improve the healthcare industry. The ideal QA candidate will have a well-rounded knowledge of insurance payers, arbitration/litigation processes, coding, and excellent interpersonal communication skills. Key Responsibilities Include (but are not limited to):
- Maintain a thorough understanding of the process, current medicolegal regulations, and updates to regulations.
- Conduct continuous analysis/audits of the experts findings to ensure compliance with the industry's regulations.
- Ability to ensure timely completion of all components of the audit.
- Track trend data over time to determine if performance standards are being met.
- Track and respond to requests from arbitrators by submitting all supporting documentation to assigned arbitrators.
- Submit experts final determinations through the appropriate computer systems.
- Ability to meet deliverables, quality assurance and methodology standards.
Knowledge, Skills, and Abilities:
- Robust knowledge of medicolegal field
- Above average verbal and written communication skills.
- Familiar with emergency room, physical therapy, operative, and hospital coding and billing processes.
- Paralegal experience or medical coding experience is preferred.