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DQCC Analyst (Medical Claims Processing Analyst)

Medusind Solutions

Medusind Solutions

Posted on Wednesday, July 12, 2023
Location: Remote
Job Description:

The DQCC Billing Specialist is responsible for all aspects of clean claims processing as well as 100% patient capture. This includes,
but is not limited to, items outlined below. Additionally, the DQCC Billing Specialist is responsible for the front-end, quality claim
processing functions and job duties associated with the assigned grouping of clients. Charges, goals, issues, patients, cases and more
must be monitored ongoing to ensure all runs smoothly. Reporting, rejection review, edits, audits and open-ended communication are
essential to ensure success. The DQCC Billing Specialist must respond timely, educate, audit and provide feedback. Client data must
be analyzed and trends identified. Excellent communication skills are essential to success. A DQCC Billing Specialist provides
meaningful information to Client Service Managers or their designee, internal and external team members, contacts, patients,
insurance companies and vendors. By analyzing data and exercising good judgement, issues can be prevented or quickly resolved.
The expectation is to continually improve processes, create efficiencies, increase revenue and generate client satisfaction.

  • Accountable for clients’ statistical performance reporting in a timely manner
  • Accountable for 100% patient capture – ensure all batches/patients are received
  • Goal of 100% clean claim rate
  • Maintain current documentation and nuances for lead clients and applicable processes
  • Extensive quality auditing
  • Daily Clean Claim effort: research, correct, improve established company processes and protocol
  • Provide feedback, education and responses to business partners and issue resolution
  • Compile and process physician billing data
  • Phone calls to patients, insurance carriers and clients (inbound & outbound)
  • Interact professionally and positively with third parties, clients, vendors and team
  • Test new systems and processes
  • Cross-train, train and provide team coverage
  • Resolve fallout with appropriate actions for all front-end functions such as Batch Prep, Registration/EDemo,
  • Coding (skill level dependent), Data Entry/Rekeys, Scanning and other related functions as needed
  • Project management
  • Other duties as assigned.

Skills & Requirements:

  • Healthcare experience
  • Manage day-to-day workload and assist with all functions as needed
  • Communicate professionally with patients, insurance companies, associates, management and clients
  • Excellent problem solving skills, highly efficient and ability to motivate others
  • Ability to strike the balance between quality and quantity output and achieve excellence in both areas
  • Ability to work well within a team or independently with a positive attitude
  • High level of proficiency with computers and various applications including MS Office Suite
  • Excellent data entry and 10 key skills
  • Proven track record of problem resolution through process improvement, innovation and technology
  • Project Management and Implementation
  • Certified Medical Coding, Anatomy, Medical Terminology, Human Physiology a plus
  • Experience with EMR/HER implementation and processing preferred
  • Auditing and Quality Analysis a plus
  • Experience with claim processing and outsourcing a plus
  • Technical writing / documentation and training skills a plus