QA Auditor Level I

Position Summary

• The QA Team audits critical fields on all provider HCFAs & UBs against re-priced MedRisk Generated EOBs or MedRisk Generated HCFAS before mailing.
• Trends are observed, identifying key systematic issues.
• QA team offers above standard quality on all bills before mailed.
• Confirming accuracy of billing data, routinely interacts with medata application for re-pricing incorrect bills.

Primary Duties & Responsibilities

• Audit all Workers Compensation bills re-priced through “Medata or Bridge”.

• Meet/exceed audit productivity and quality standards to maintain the integrity of the claim/bill.

• Maintain and report individual and team claim/bill backlogs, ensuring that all claims are QA’d within printed receive dates, audited within objective 2 days TAT goal.

• Determine error sources and accurate entry of claim audits, document with accuracy in QA Printing Production Excel log kept on Folks2 drive

• Interpret and understand MedRisk carrier contracts “CQ” and basic knowledge of state guidelines compliance, and HIPPA regulations.

• Review error trend reports and participate in rebuttal process for continuous improvement; providing feedback to Quality Assurance and CDT teams.

• Provide one-on-one training as needed with associates and actively participate in Quality Assurance Team meetings.

• Perform focused audits, working with varying types of data.

• Complete other clerical or support duties as assigned.

• Lead by example, demonstrate good promptness and adhere to company policies for yearly attendance.

Qualifications

• Detail-oriented with strong organizational, time management and problem-solving abilities.

• Preferred extensive knowledge of general Workers Compensation billing procedures including knowledge of CPT Coding, ICD-10, and HCPC

• Strong organizational, time management and project management skills with multi-tasking abilities.

• Manage multiple priorities, maintain confidentiality, and display a courteous, patient, and helpful attitude toward employees.

• Basic understanding of HIPPA policies and procedures.

• Ability to multi-task, adapt quickly to change and follow projects through completion

• MS Office Products; Word, Excel and Outlook experience

Competencies (choose at least 4)