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Job TitleQuality Review Analyst
Job SummaryThe Quality Review Analyst is responsible for the accurate and timely review of the Medicare/Medicaid workload and ensures consistency and quality administration of the Centers for Medicare & Medicaid Services (CMS) regulations. This position communicates in a professional manner while maintaining a high level of confidentiality and provides feedback to front line staff in a respectful and considerate manner about issues that may arise.
Key Performance Indicators- Analytical ability and attention to details
- Ability to maintain confidentiality
- Excellent customer service
- Performs timely and accurate quality assurance reviews of critical work tasks completed by staff
- Acquires a detailed working knowledge of Medicare and organization regulations, policies, team functions and procedures, medical terminology, Claims Processing Timeliness (CPT), and ICD-9 coding and Medicare bulletins
- Monitors and reports quality review statistics
- Pays close attention to the details of all work and strives for a high level of accuracy
- Applies critical thinking, analysis, and evaluation always giving due consideration to the evidence, the context of judgement, relevant criteria, and nature of the problem or question at hand to make accurate and timely decisions
- Ability to work multiple workloads during the day
- Ability to review, analyze, and complete special projects as needed
- Remains objective when inconsistencies or irregularities are identified within work
- Adapts routine processes accordingly to achieve favorable results
- Builds constructive working relationship with clients/customers, other work units, and other individuals to meet mutual goals and objectives
- Contributes positively to a team-based work environment
- Other duties as assigned
- High school diploma or GED
- 1-year Medicare experience
- Accurate data entry skills
- Demonstrated problem solving skills
- Ability to provide and receive constructive feedback
- Above requirements and the following:
- Excellent communication skills
- Office Environment
- Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
- Requires prolonged sitting and telephone use
- Requires the use of office equipment such as computer terminals, telephones, copiers and printers
- Infrequent lifting to 15 pounds
- Infrequent stooping
Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.
Statement of Other DutiesThis document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.
Total Rewards Package:Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.
CMS Access Compliance and Regulation Contingency StatementSome positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.
Equal Employment OpportunityEqual Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.
Below is the salary range for potential new hires.
Salary Range: $17.20 - $27.47 per hour
Other Compensation: Incentive Plan
This job will be closed 4/30/2024 at 8:00AM CST. No further applications will be considered.
Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.