Analyst - RCM Quality & Outcome Improvement - Healthcare

RCM Quality and Outcome Improvement Analyst

Your Role:

- Play a critical role in meeting productivity targets, delivering a high level of customer service, and ensuring ModMed's overall service delivery is consistently maintained at the highest standards while ensuring ModMed's billing and compliance processes and Standard Operating Procedures (SOPs) are followed.

- Responsible for identifying and addressing opportunities to improve workflows and reduce non-meaningful touches by analyzing trends on inflows of claim-level assignments.

- Set up and manage online portals following the requirements and payer details provided by global partners, including, but not limited to, creating W9 forms and following up with payers.

- Work claims escalated from global partners, practices and onshore teams as per Standard Operating Procedures. (SOPs). Including but not limited to:

- Analyze claims addressed for credentialing issues from global partners and work closely with onshore to resolve credentialing issues.

- Review claims assigned to practice for quality and determine if decision tree enhancements will prevent future escalation of a similar claim.

- Analyze Dashboards/Reports for production and AR trends to identify quality issues; sample the claims and fill out Quality Analysis forms.

- Run reports regularly and maintain a status tracker to keep a close eye on various inventories to ensure global partners are working on the claims timely.