job description
Are you an experienced US Registered Nurse (USRN) looking to pivot your clinical expertise into the dynamic world of healthcare quality assurance and revenue cycle management? Our team is seeking a detail-oriented USRN Quality Analyst with a deep understanding of US hospital billing processes to join our Manila-based operations. In this critical role, you will bridge the gap between clinical documentation and financial integrity, ensuring that all claims meet high standards of accuracy, compliance, and efficiency.
As a Quality Analyst, you will conduct thorough audits of patient records and billing codes, identifying discrepancies and opportunities for process improvement. We offer a highly competitive salary package and a supportive environment where your clinical background is valued as a strategic asset. If you are a methodical professional with a passion for process excellence and US healthcare regulations, we invite you to advance your career with us.
Responsibility
- Conduct comprehensive quality audits on US hospital billing claims and clinical documentation to ensure regulatory compliance.
- Analyze denied claims to identify root causes and provide actionable insights to the billing and coding departments.
- Monitor and evaluate the accuracy of medical coding (ICD-10, CPT, HCPCS) against clinical records.
- Collaborate with cross-functional teams to streamline workflows and reduce billing error rates.
- Maintain up-to-date knowledge of US insurance payer policies, government regulations, and industry standard billing practices.
- Prepare detailed performance reports and dashboards for stakeholders to track quality metrics.
- Provide training and feedback to staff based on audit findings to promote continuous improvement.
- Ensure all internal quality standards and HIPAA privacy requirements are strictly adhered to.
Qualifications
- Active and unrestricted US Registered Nurse (USRN) license (or eligibility to practice).
- Minimum of 2-3 years of experience in clinical nursing and/or medical coding/billing audit roles.
- Proven track record of auditing hospital billing, medical records, or claims processing.
- In-depth knowledge of US healthcare revenue cycle management and hospital billing operations.
- Strong analytical, critical thinking, and investigative skills with a high level of attention to detail.
- Proficiency in Microsoft Office Suite (especially Excel) and electronic health record (EHR) systems.
- Excellent communication skills, both written and verbal, in a professional business environment.
- Ability to work independently and manage multiple priorities in a fast-paced setting.